本文選題：llizarov技術(shù) + 脛骨�。� 參考：《昆明醫(yī)科大學(xué)》2015年碩士論文

【摘要】：研究背景：脛骨感染性骨不連及骨缺損是創(chuàng)傷骨科常見(jiàn)疾患。因常伴隨小腿軟組織缺損、骨外露,加之脛骨中下段自身血循環(huán)差,導(dǎo)致治療極為困難。傳統(tǒng)的治療方法很難兼顧到治愈感染同時(shí)修復(fù)骨、軟組織缺損,恢復(fù)傷肢長(zhǎng)度,臨近關(guān)節(jié)畸形矯正,后期常合并足下垂、跟腱攣縮、關(guān)節(jié)僵硬、肢體短縮等并發(fā)癥。目的：探討Ilizarov技術(shù)治療脛骨感染性骨不連及骨缺損的臨床療效,分析該技術(shù)的優(yōu)缺點(diǎn)及其最佳適應(yīng)癥。方法：回顧性分析成都軍區(qū)昆明總醫(yī)院自2012年7月至2014年12月收治的脛骨感染性骨不連及骨缺損15例,其中男10例,女5例；年齡20-55歲,平均36.5歲；交通傷10例,摔傷2例,壓砸傷3例。感染性骨不連6例,感染性骨缺損9例,骨缺損長(zhǎng)度2-15cm,平均8.5cm。所有病例均合并軟組織缺損。5例合并足下垂畸形。9例一期行清創(chuàng)、Ilizarov外固定架固定、截骨、骨搬運(yùn)：6例一期行清創(chuàng)、Ilizarov外固定架固定,二期截骨、骨搬運(yùn)。12例創(chuàng)面開(kāi)放換藥,3例采取皮瓣轉(zhuǎn)移修復(fù)創(chuàng)面,其中1例采用腓腸肌內(nèi)側(cè)頭肌皮瓣修復(fù),1例采用隱神經(jīng)營(yíng)養(yǎng)血管皮瓣修復(fù),1例采用腓腸神經(jīng)營(yíng)養(yǎng)血管皮瓣修復(fù)。結(jié)果：所有患者均獲12-24個(gè)月隨訪,平均18個(gè)月,均獲得愈合,無(wú)一例感染復(fù)發(fā),肢體功能良好,足下垂畸形矯正滿意。術(shù)后定期行X線攝片檢查評(píng)估骨愈合情況,愈合時(shí)間4-20個(gè)月,平均1O個(gè)月；肢體長(zhǎng)度恢復(fù)良好,與健側(cè)對(duì)比無(wú)明顯差異。主要并發(fā)癥：針道感染5例,骨端對(duì)位不良8例,皮膚牽拉痛12例,8例出現(xiàn)不同程度的踝關(guān)節(jié)功能障礙。結(jié)論：采取Ilizarov技術(shù)治療脛骨感染性骨不連及骨缺損,療效滿意,該技術(shù)尤其適于脛骨大段骨缺損合并軟組織缺損、肢體短縮、跟腱攣縮、足下垂等畸形的病例。
[Abstract]:Background: infectious nonunion and bone defect of tibia are common diseases in orthopedic trauma. Often accompanied by soft tissue defects of the leg, bone exposure, and poor blood circulation in the middle and lower tibia, treatment is extremely difficult. It is difficult to cure infection and repair bone and soft tissue defect, restore the length of injured limb, close to joint deformity correction, often complicated with foot droop, Achilles tendon contracture, joint stiffness, limb shortening and other complications. Objective: to investigate the clinical efficacy of Ilizarov technique in the treatment of tibial infectious nonunion and bone defect, and to analyze the advantages and disadvantages of Ilizarov technique and its optimal indications. Methods: from July 2012 to December 2014, 15 cases of infectious nonunion and bone defect of tibia were retrospectively analyzed in Kunming General Hospital of Chengdu military region, including 10 cases of male and 5 cases of female, aged 20-55 years (mean 36.5 years), 10 cases of traffic injury and 2 cases of falling injury. There were 3 cases of crush injury. Infectious nonunion occurred in 6 cases and infectious bone defect in 9 cases. The length of bone defect was 2-15 cm (mean 8.5 cm). All cases were complicated with soft tissue defect in 5 cases and foot droop deformity in 9 cases. All cases were treated with debridement Ilizarov external fixation, osteotomy, bone transport: 6 cases were treated with debridement Ilizarov external fixator and secondary osteotomy. Bone transfer. 3 cases were treated with flap transfer, 1 case with medial gastrocnemius musculocutaneous flap, 1 case with saphenous neurovascular flap and 1 case with sural neurovascular flap. Results: all the patients were followed up for 12 to 24 months with an average of 18 months. None of the patients had any recurrence of infection, good limb function and satisfactory correction of foot droop deformity. The healing time was 4-20 months with an average of 10 months, and the limb length recovered well, but there was no significant difference between the limb length and the normal side. The main complications were: needle infection in 5 cases, bone end misalignment in 8 cases, skin traction pain in 12 cases and ankle dysfunction in 8 cases. Conclusion: Ilizarov technique is effective in the treatment of tibial infectious nonunion and bone defect. This technique is especially suitable for large tibial bone defect with soft tissue defect, limb shortening, Achilles tendon contracture, foot drooping and so on.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

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本文編號(hào)：2098678