| 胫骨骨搬移后再骨折的临床观察 |
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Received:September 09, 2022
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| 期刊信息：《中国骨伤》2022年35卷，第10期，第927-932页 |
| DOI：10.12200/j.issn.1003-0034.2022.10.005 |
| 基金项目:河北省重点研发计划项目(编号:20377744D) |
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目的:基于采用Ilizarov骨搬移技术治疗胫骨骨缺损后发生再骨折的19例患者的临床资料,总结分析该类患者的临床特点及治疗效果。
方法:回顾性分析2010年8月至2020年1月应用Ilizarov骨搬移技术治疗后发生再骨折的19例胫骨感染性骨缺损患者的临床资料,其中男18例,女1例;年龄15~66(37.7±13.0)岁。再骨折致伤原因:摔伤4例,砸伤1例,撞伤1例,无明显外伤史13例。再骨折发生的时间:2例外固定架尚未拆除时,发生同侧股骨远端骨折;其余17例最短1 d,最长30个月。再骨折部位:再生区8例,对接点9例,同侧股骨干2例。按笔者新提出的改良Simpson分型进行再骨折分类,再骨折治疗方法包括石膏托固定、牵引或外固定架固定。采用Ilizarov方法研究与应用学会(Association for the Study and Application of the Method of Ilizarov,ASAMI)标准进行骨愈合与功能评价。
结果:所有患者获得随访,时间9~17(12.3±3.2)个月。按改良Simpson分型:Ⅰa型3例,Ⅰb型1例,Ⅰc型3例,Ⅱ型1例,Ⅲ型9例,Ⅴ型2例。所有再骨折愈合,无一例发生感染。保守治疗6例,骨折愈合时间分别为3、5、3、2、2、2个月,其中1例发生成角约20°的畸形愈合。手术治疗13例,骨折愈合时间为2~6(4.4±1.4)个月。按ASAMI评分标准:骨愈合均为优。功能结果优6例,良13例,其主要原因为踝关节或膝关节僵直。
结论:新的改良Simpson分型与骨搬移后再骨折的临床实际类型更为贴切,对临床治疗方式的选择有一定的指导意义,外固定架治疗再骨折是一个简单、有效的方法。 |
| [关键词]:胫骨骨折|骨髓炎|骨搬移|再骨折 |
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| Clinical therapeutic strategies of refracture after bone transport for tibial bone defect |
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Abstract:
Objective: To explore the clinical therapeutic strategies of refracture after Ilizarov bone transport technique in the treatment of tibial bone defect.
Methods: A retrospective study was performed on 19 patients with infected tibial bone defect treated by Ilizarov bone transport technique and then refracture from August 2010 to January 2020,including 18 males and 1 female with an average age of (37.7±13.0) years old ranging from 15 to 66 years old. Cause of injury invlved falling injury in 4 cases,crashing injury 1 case,crushing injury in 1 case and without obvious injury history in 13 cases. The ipsilateral distal femoral fracture in 2 cases occurred before the external fixator of tibia was removed,and the other 17 cases had a minimum of 1 day and a maximum of 30 months after the external fixator had been removed. The site of refracture was at regenerative zone in 8 cases,at docking site in 9 cases,at ipsilateral femoral shaft in 2 cases. According to the modified Simpson classification proposed by the author,the refracture was classified. The treatment of refracture include plaster splint,traction or external fixation. Bone healing and function were evaluated according to the standards of the Association for the Study and Application of the Method of Ilizarov(ASAMI).
Results: All patients were followed up,and the duration ranged from 9 to 17 months with an average of (12.3±3.2) months. According to the modified Simpson classification,there were 3 cases of type Ⅰa,1 case of type Ⅰb,3 cases of type Ⅰc,1 case of type Ⅱ,9 cases of type Ⅲ and 2 cases of type Ⅴ. All the refractures healed without infection or malunion. The fracture healing time of conservative treatment for 6 cases were 3,5,3,2,2,2 months fespectively;and the healing time of fracture treated by surgery for 13 cases was 2 to 6 months,with an average of(4.4±1.4) months. According to ASAMI evaluation criteria,bony results showed all patients obtained excellent results,and functional results showed 6 patients got excellent results,13 good beacause of ankle or knee stiffness.
Conclusion: The modified Simpson classification could contain most clinical types of refracture after bone transport,and the external fixation is a simple and effective method for refracture. |
| KEYWORDS:Tibial fractures|Osteomyelitis|Bone transport|Refracture |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 张彦龙,刘士波,王泳,吴天昊,桑睿政,董健伟,李鹏飞,吴希瑞,彭阿钦.胫骨骨搬移后再骨折的临床观察[J].中国骨伤,2022,35(10):927~932 |
| 英文格式: | ZHANG Yan-long,LIU Shi-bo,WANG Yong,WU Tian-hao,SANG Rui-zheng,DONG Jian-wei,LI Peng-fei,WU Xi-rui,PENG A-qin.Clinical therapeutic strategies of refracture after bone transport for tibial bone defect[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(10):927~932 |
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