Ilizarov骨搬运技术治疗Gustilo ⅢB型、C型胫骨大段骨缺损合并软组织缺损的效果分析
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摘要
目的探讨Ilizarov骨搬运技术治疗GustiloⅢB型、C型胫骨大段骨缺损合并软组织缺损的效果。方法选取2016年1～12月本院收治胫骨大段骨缺损合并软组织缺损患者30例(ⅢB型25例,ⅢC型5例),均为胫骨开放性骨折。对所有患者采取Ilizarov外固定骨搬运技术治疗。结果所有患者随访10～28个月,平均15个月;骨缺损均得以重建,患肢长度与健侧之差小于2 cm,骨折愈合,创面均闭合。1例术后出现腓总神经麻痹,术后3个月恢复。22例未通过额外手术进行修复。5例通过游离皮片植皮成活,3例通过局部旋转皮瓣修复覆盖创面。结论 Ilizarov骨搬运技术是临床治疗GustiloⅢB型、C型胫骨大段骨缺损合并软组织缺损的有效方法之一。
Objective To investigate the efficacy of Ilizarov technique in treatment of Gustilo type Ⅲ B and C of large tibia bone defect combined with soft tissue defect.Methods Thirty cases with large tibia bone defect combined with soft tissue defect in our hospital from January 2016 to December 2018 were selected including 25 cases with type Ⅲ B and 5 cases with type Ⅲ C,who were all open tibia fractures and treated with Ilizarov technique.Results All patients were followed up for 10 to 18 months with an average of 15 months.The bone defects were reconstructed,the difference between the length of the affected limb and the healthy side was less than 2 cm.The fracture was healed and the wound was closed.One case was with paralysis of common peroneal nerve and recoveried after 3 months.Twenty-two cases recovered without extra surgery,five cases restored with skin graft and three cases covered the wound by rotating skin flap.Conclusion Ilizarov technique is one of effective ways to treat Gustilo Ⅲ type B and type C of large defect combined with soft tissue defect.
Objective To investigate the efficacy of Ilizarov technique in treatment of Gustilo type Ⅲ B and C of large tibia bone defect combined with soft tissue defect.Methods Thirty cases with large tibia bone defect combined with soft tissue defect in our hospital from January 2016 to December 2018 were selected including 25 cases with type Ⅲ B and 5 cases with type Ⅲ C,who were all open tibia fractures and treated with Ilizarov technique.Results All patients were followed up for 10 to 18 months with an average of 15 months.The bone defects were reconstructed,the difference between the length of the affected limb and the healthy side was less than 2 cm.The fracture was healed and the wound was closed.One case was with paralysis of common peroneal nerve and recoveried after 3 months.Twenty-two cases recovered without extra surgery,five cases restored with skin graft and three cases covered the wound by rotating skin flap.Conclusion Ilizarov technique is one of effective ways to treat Gustilo Ⅲ type B and type C of large defect combined with soft tissue defect.
引文
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[10]张永强,赵平,耿家金,等.Ilizarov骨迁移治疗胫骨大段骨缺损的临床疗效[J].临床骨科杂志,2013,16(3):293-295.doi:10.3969/j.issn.1008-0287.2013.03.021.
[11]沈勇,王彦生,张辉,等.Ilizarov外固定架治疗胫骨骨缺损及骨短缩[J].实用手外科杂志,2013,27(2):148-149.
[12]孙晓,彭爱民,殷照阳,等.Ilizarov骨搬运技术治疗胫骨骨缺损临床观察[J].河北医药,2013,35(12):1859-1960.doi:10.3969/j.issn.1002-7386.2013.12.054.
[13]杨文博,李盛华,刘红喜,等.Ilizarov骨搬移技术治疗胫骨创伤性骨髓炎并发症分析[J].甘肃医药,2017,36(6):480-481.doi:10.15975/j.cnki.gsyy.2017.06.029.
[14]Zhai J,Weng X,Zhang B,et al.Management of knee flexion contracture in haemophilia with the Ilizarov technique[J].Knee,2018.doi:10.1016/j.knee.2018.08.006.
[15]Y9rüko4lu UH,Gürkan Y.Combined quadratus lumborum block and lumbar plexus block for a pediatric patient undergoing ilizarov procedure[J].J Clin Anesth,2018,49:40-41.doi:10.1016/j.jclinane.2018.06.002.
[16]扈克治,甘干达,罗平,等.Ilizarov骨搬移技术在治疗胫骨骨缺损过程中造成足下垂6例分析[J].华南国防医学杂志,2017,31(8):576-577.doi:10.13730./j.issn.1009-25952017.08.022.
[17]杨兵,何忠,梁周.应用Ilizarov一期骨短缩-延长术治疗胫骨感染性大段骨缺损和(或)合并软组织缺损的疗效观察[J].广西医学,2018,40(19):2293-2296.doi:10.11675/j.issn.0253-4304.2018.19.12.
[18]黄涛,曲玲玲,洪焕玉,等.双段骨组织牵拉再生技术治疗胫骨大段骨缺损[J].中国骨与关节损伤杂志,2013,28(6):583-584.doi:10.7531/j.issn.1672-9935.2013.06.043.
[19]魏星,雷金来,王虎,等.Ilizarov骨搬移技术在胫骨骨折术后骨感染骨缺损中的应用[J].中国骨与关节损伤杂志,2016,31(4):373-376.doi:10.7531/j.issn.1672-9935.2016.04.011.
[20]曹建明,周亚净,朱巧辉,等.择期Ilizarov骨搬移技术治疗胫骨感染性骨缺损[J].实用骨科杂志,2016,22(11):980-984.doi:10.13795/j.cnki.sgkz.2016.11.006.
[21]沙佳,徐会法,严亚波,等.Ilizarov外固定架非对称性延长一期治疗股骨短缩合并重度膝外翻畸形[J].中国矫形外科杂志,2017,25(4):297-302.doi:10.3977/j.issn.1005-8478.2017.04.03.
[22]韩立仁,穆卫东,陈志强,等.Ilizarov骨搬移技术治疗胫骨大段骨缺损合并软组织缺损[J].中华创伤杂志,2011,27(10):901-904.doi:10.3760/cma.jissn.1001-8050.2011.10.013.
[23]闫志强.应用Ilizarov技术一期治疗下肢长管状骨缺损合并软组织缺损的临床研究[J].山东医药,2015,55(26):70-72.doi:10.3969/j.issn.1002-266X.2015.26.026.
[24]Zhong W,Lu S,Chai Y,et al.One-stage reconstruction of complex lower extremity deformity combining ilizarov external fixation and sural neurocutaneous flap[J].Ann Plast Surg,2015,74(4):479-483.doi:10.1097/SAP.0000000000000479.
[2]武进华,冯志斌,张建河,等.骨段滑移术治疗胫骨缺损合并软组织缺损[J].实用骨科杂志,2012,18(2):132-136.doi:10.3969/j.issn.1008-5572.2012.02.011.
[3]王兴义.Ilizarov技术一期短缩延长术治疗感染性大段骨缺损[J].中国矫形外科杂志,2015,23(3):229-234.doi:10.3997/j.issn.1005-8478.2015.03.08.
[4]雷中华,林杨,方文广.Ilizarov骨短缩-延长术治疗胫骨大段骨缺损合并软组织缺损的临床疗效[J].蚌埠医学院学报,2017,42(10):1383-1385.doi:10.13898/j.cnki.issn.1000-2200.2017.10.028.
[5]殷渠东,孙振中,顾三军,等.骨短缩延长术治疗胫骨大段骨缺损合并软组织缺损[J].中国修复重建外科杂志,2013,27(12):1462-1465.doi:10.7507/1002-1892.20130321.
[6]陈文峰.Ilizarov骨搬移技术在促进创伤性骨髓炎患者肢体功能中的机制研究[J].中国现代药物应用,2016,10(20):95-96.doi:10.14164/j.cnki.cn11-5581/r.2016.20.061.
[7]殷照阳,殷建,孙晓,等.Ilizarov骨搬移技术治疗胫骨感染性骨缺损合并软组织缺损[J].重庆医学,2015,44(29):4108-4111.doi:10.3969/j.issn.1671-83482015.29.026.
[8]贺新兵,韩立仁,闫军,等.应用Ilizarov骨搬运技术治疗胫骨大段骨缺损[J].中国临床医生杂志,2015,43(5):56-58.doi:10.3969/j.issn.2095-8552.2015.05.020.
[9]马兴明.胫骨后侧平台骨折创伤关节镜下手术治疗临床研究[J].中国医学前沿杂志(电子版),2013,5(12):61-64.
[10]张永强,赵平,耿家金,等.Ilizarov骨迁移治疗胫骨大段骨缺损的临床疗效[J].临床骨科杂志,2013,16(3):293-295.doi:10.3969/j.issn.1008-0287.2013.03.021.
[11]沈勇,王彦生,张辉,等.Ilizarov外固定架治疗胫骨骨缺损及骨短缩[J].实用手外科杂志,2013,27(2):148-149.
[12]孙晓,彭爱民,殷照阳,等.Ilizarov骨搬运技术治疗胫骨骨缺损临床观察[J].河北医药,2013,35(12):1859-1960.doi:10.3969/j.issn.1002-7386.2013.12.054.
[13]杨文博,李盛华,刘红喜,等.Ilizarov骨搬移技术治疗胫骨创伤性骨髓炎并发症分析[J].甘肃医药,2017,36(6):480-481.doi:10.15975/j.cnki.gsyy.2017.06.029.
[14]Zhai J,Weng X,Zhang B,et al.Management of knee flexion contracture in haemophilia with the Ilizarov technique[J].Knee,2018.doi:10.1016/j.knee.2018.08.006.
[15]Y9rüko4lu UH,Gürkan Y.Combined quadratus lumborum block and lumbar plexus block for a pediatric patient undergoing ilizarov procedure[J].J Clin Anesth,2018,49:40-41.doi:10.1016/j.jclinane.2018.06.002.
[16]扈克治,甘干达,罗平,等.Ilizarov骨搬移技术在治疗胫骨骨缺损过程中造成足下垂6例分析[J].华南国防医学杂志,2017,31(8):576-577.doi:10.13730./j.issn.1009-25952017.08.022.
[17]杨兵,何忠,梁周.应用Ilizarov一期骨短缩-延长术治疗胫骨感染性大段骨缺损和(或)合并软组织缺损的疗效观察[J].广西医学,2018,40(19):2293-2296.doi:10.11675/j.issn.0253-4304.2018.19.12.
[18]黄涛,曲玲玲,洪焕玉,等.双段骨组织牵拉再生技术治疗胫骨大段骨缺损[J].中国骨与关节损伤杂志,2013,28(6):583-584.doi:10.7531/j.issn.1672-9935.2013.06.043.
[19]魏星,雷金来,王虎,等.Ilizarov骨搬移技术在胫骨骨折术后骨感染骨缺损中的应用[J].中国骨与关节损伤杂志,2016,31(4):373-376.doi:10.7531/j.issn.1672-9935.2016.04.011.
[20]曹建明,周亚净,朱巧辉,等.择期Ilizarov骨搬移技术治疗胫骨感染性骨缺损[J].实用骨科杂志,2016,22(11):980-984.doi:10.13795/j.cnki.sgkz.2016.11.006.
[21]沙佳,徐会法,严亚波,等.Ilizarov外固定架非对称性延长一期治疗股骨短缩合并重度膝外翻畸形[J].中国矫形外科杂志,2017,25(4):297-302.doi:10.3977/j.issn.1005-8478.2017.04.03.
[22]韩立仁,穆卫东,陈志强,等.Ilizarov骨搬移技术治疗胫骨大段骨缺损合并软组织缺损[J].中华创伤杂志,2011,27(10):901-904.doi:10.3760/cma.jissn.1001-8050.2011.10.013.
[23]闫志强.应用Ilizarov技术一期治疗下肢长管状骨缺损合并软组织缺损的临床研究[J].山东医药,2015,55(26):70-72.doi:10.3969/j.issn.1002-266X.2015.26.026.
[24]Zhong W,Lu S,Chai Y,et al.One-stage reconstruction of complex lower extremity deformity combining ilizarov external fixation and sural neurocutaneous flap[J].Ann Plast Surg,2015,74(4):479-483.doi:10.1097/SAP.0000000000000479.