【摘要】：目的探討采用肢體短縮延長術治療脛骨感染性骨缺損及慢性骨髓炎的療效。方法 2011年1月—2016年4月采用肢體短縮延長術治療脛骨感染性骨缺損及慢性骨髓炎19例。男13例,女6例;年齡22~62歲,平均44歲。致傷原因:交通事故傷16例,壓砸傷1例,高處墜落傷2例。18例為小腿開放性骨折(GustiloⅢB型)外固定支架固定后形成感染性骨缺損、骨髓炎,1例為閉合骨折內固定術后感染形成慢性骨髓炎。既往手術2~5次,平均3次。受傷至骨搬移術時間為3~11個月,平均6.5個月。清創(chuàng)后骨缺損長度為2.0~5.5 cm,平均4.3 cm。術中脛骨短縮后松開止血帶檢查肢體末梢血運,7例直接閉合創(chuàng)面,5例采用鄰近皮瓣修復,5例采用腓腸神經營養(yǎng)血管皮瓣修復,1例采用腓腸肌內側頭肌皮瓣修復,1例單純植皮修復。選用單臂外固定架或環(huán)式外固定架,并在脛骨近側或遠側干骺端的兩排外固定架釘之間完全鋸斷;1周后以1 mm/d速度進行肢體延長。結果術后19例患者均獲隨訪,隨訪時間10~36個月,平均14個月。2例對合端創(chuàng)面延遲愈合,余均順利愈合。18例對合骨端自然愈合,1例因病灶骨未完全切除致對合骨端發(fā)生骨不連。5例發(fā)生牽張骨痂生長緩慢,其中4例經"手風琴"技術和注射紅骨髓后順利愈合,1例植骨輔助內固定后對合骨端愈合。骨延長時間為1~3個月,延長指數為1.6~2.7 cm/月,平均2.2 cm/月;骨愈合時間為7~13個月,平均11.1個月。根據脛骨骨折療效評定系統(tǒng)Johner-Wruhs評分評定療效:優(yōu)9例,良8例,中2例,優(yōu)良率為89.5%。結論采用肢體短縮延長術治療脛骨感染性骨缺損及慢性骨髓炎,可改善截骨端的直接對合,明顯縮短骨對合端的愈合時間。
[Abstract]:Objective to evaluate the efficacy of limb shortening and lengthening in the treatment of tibial bone defect and chronic osteomyelitis. Methods from January 2011 to April 2016, 19 cases of tibial bone defect and chronic osteomyelitis were treated with limb shortening and lengthening. There were 13 males and 6 females, aged 22 to 62, with an average of 44 years old. The causes of injury were traffic accident injury (16 cases), crush injury (1 case) and high fall injury (2 cases). 18 cases were infected bone defect and osteomyelitis after external fixation of open leg fracture (Gustilo type 鈪，

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