| 应用Ilizarov技术一期治疗合并皮肤缺损的胫骨感染性骨缺损 |
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Received:December 25, 2009
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| 作者 | Author | 单位 | Unit | E-Mail |
| 王兴国 |
WANG Xing-guo |
北京骨髓炎医院,北京 102206 |
The Osteomyelitis Hospital of Beijing,Beijing 102206,China |
wangxingguo666@sohu.com |
| 王伟 |
WANG Wei |
北京骨髓炎医院,北京 102206 |
The Osteomyelitis Hospital of Beijing,Beijing 102206,China |
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| 王兴义 |
WANG Xing-yi |
北京骨髓炎医院,北京 102206 |
The Osteomyelitis Hospital of Beijing,Beijing 102206,China |
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| 吕磊 |
LV Lei |
北京骨髓炎医院,北京 102206 |
The Osteomyelitis Hospital of Beijing,Beijing 102206,China |
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| 王公奇 |
WANG Gong-qi |
北京骨髓炎医院,北京 102206 |
The Osteomyelitis Hospital of Beijing,Beijing 102206,China |
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| 麻庆松 |
MA Qing-song |
北京骨髓炎医院,北京 102206 |
The Osteomyelitis Hospital of Beijing,Beijing 102206,China |
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| 苏桂有 |
SU Gui-you |
北京骨髓炎医院,北京 102206 |
The Osteomyelitis Hospital of Beijing,Beijing 102206,China |
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| 期刊信息：《中国骨伤》2010年23卷，第6期，第422-425页 |
| DOI：10.3969/j.issn.1003-0034.2010.06.008 |
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目的：探讨应用Ilizarov技术治疗合并皮肤缺损的胫骨感染性骨缺损临床疗效。
方法：2001年至2008年应用Ilizarov技术治疗合并大面积皮肤缺损的胫骨感染性骨缺损21例，其中男18例，女3例；年龄19～43岁，平均31岁。骨缺损3～13 cm，平均6 cm；皮肤缺损面积3 cm×3 cm～6 cm×10 cm。11例合并足下垂，5例合并膝关节强直。术前拍摄患肢X线片和标定皮肤坏死区域，确定术中截除病骨长度，搬运骨截骨平面，骨与软组织清创范围等。术前如有内固定，则取出内固定。术后应用开放冲洗，VSD(vacuum sealing drainage)或开放换药。全部病例应用Ilizarov 技术在搬运骨段克氏针固定皮肤，术后4～7 d骨搬运与皮肤同时延长，每日4～6次，每次1/6～1/4 mm。观察创面新鲜状况，皮肤延长程度，确定临床疗效。
结果：21例均得到随访，时间6～62个月，平均49.5个月。21例中14例骨感染Ⅰ期全部治愈；3例在骨对接端仍有分泌物存在，清创后炎症治愈，骨愈合；4例搬运骨残端再次修整加压后愈合。18例骨缺损全部补足，另3例有2例在骨对接愈合中骨对接端吸收呈轻度鼠尾状和1例对接端部分缺乏血运，取自体髂骨植骨成活。18例皮肤延长Ⅰ期愈合，3例未能Ⅰ期愈合，在对接时骨段有分泌物直到骨感染控制后愈合。所有合并足下垂病例得到矫正，膝关节功能得到改善。平均去除外固定架时间1.2～2.6年，骨感染治愈，骨与皮肤缺损修复。
结论：对于合并皮肤缺损的胫骨感染性骨缺损，应用Ilizarov技术Ⅰ期治疗创伤小，能够避免多次复杂手术，缩短治疗时间和节省治疗费用。 |
| [关键词]:胫骨骨折 手术后并发症 感染 创伤和损伤 |
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| One stage treatment of infected tibial defects combined with skin defects with Ilizarov technique |
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Abstract:
Objective: To explore the therapeutic effectiveness of Ilizarov technique in treatment of infected tibial defects combined with overlaying skin defects.
Methods: Twenty-one cases with infected tibial defects combined with skin defects were treated between 2001 and 2008 includeing 18 males and 3 females with an average age of 31 years ranging from 19 to 43 years. The length of bone defect ranged from 3 to 13 cm(means 6 cm). Skin defect area was from 3 cm×3 cm to 6 cm×10 cm；11 cases combined with drop foot,5 cases with arthrocleisis of knee. Preoperative X-ray of the affected limb was performed and zone of skin necrosis was marked,then the point and length of osteotomized bone,and scope of bone and soft tissue need for removing were determined. The internal fixation were removed. Opening irrigation,vacuum sealing drainage(VSD),and dressing changing were appllied. The skin was fixed with Kirschner wire and bone was transferred with Ilizarov technique in all patients. The lengthening of bone and skin was carried out for 4 to 7 days after surgery,1/6 to 1/4 mm once,4 to 6 times a day. The clinical effectiveness was determined mainly through wound and lengthening of skin.
Results: All patients were followed up for from 6 to 62 months(means 49.5 months). Fourteen of 21 cases received one stage treatment,there was still secretion from end of bone in 3 patients whose bone healed after debridement,the other 4 patients were cured via trimming end of bone and compression fusion. The defects of bone were extended to full length in 18 patients. Abutting end was slightly absorbed and became rattailed in 2 cases,there was lack of blood supply to abutting ends in one patient who was cured via bone graft from iliac bone. Skin defects was cured in 18 patients with one stage treatment,the other 3 patients were cured after infection was controlled. The deformity of drop foot were corrected in 11 patients,and function of knee was improved in five patients. The external fixator was removed at 1.2 to 2.6 years after surgery. At last,bone infections were cured,defects of bone and skin recovered in all patients.
Conclusion: One stage treatment of infected tibial defects combined with skin defects using Ilizarov technique has minimal invasion with less complex surgeries,could reduce the time and expense of treatment. |
| KEYWORDS:Tibial fractures Postoperative complications Infection Wounds and injuries |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 王兴国,王伟,王兴义,吕磊,王公奇,麻庆松,苏桂有.应用Ilizarov技术一期治疗合并皮肤缺损的胫骨感染性骨缺损[J].中国骨伤,2010,23(6):422~425 |
| 英文格式: | WANG Xing-guo,WANG Wei,WANG Xing-yi,LV Lei,WANG Gong-qi,MA Qing-song,SU Gui-you.One stage treatment of infected tibial defects combined with skin defects with Ilizarov technique[J].zhongguo gu shang / China J Orthop Trauma ,2010,23(6):422~425 |
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