Ilizarov骨延长和骨搬移技术治疗下肢长骨创伤后慢性骨髓炎

摘要

目的 探讨Ilizarov骨延长和骨搬移技术治疗下肢长骨创伤后慢性骨髓炎的效果.方法 选择2005年1月-2012年12月采用Ilizarov骨延长和骨搬移技术治疗的下肢长骨创伤后慢性骨髓炎患者42例,其中股骨感染13例,胫骨感染29例.30例行病灶清除+骨折断端加压+干骺端延长治疗,12例行病灶清除+骨搬移技术治疗.结果 患者均获随访12 ～ 48个月[(15.0±4.5)个月].其中38例手术感染得到Ⅰ期控制,4例再次行1～3次清创术,最终感染均得到控制.30例行骨折断端加压-干骺端延长患者中,26例骨折Ⅰ期愈合,另4例骨不连,再次行自体骨移植术后骨折愈合.12例采用骨搬移技术治疗患者,Ⅱ期行骨折断端清理和自体骨移植后骨折愈合.截骨延长长度为2.5～11.0 cm,平均4.5 cm.延长停止和骨折愈合后,患肢长度较对侧短缩＜ 2.5 cm 36例,2.5～3.0cm4例,3.0～4.5 cm2例.术后针道感染8例,经切开引流或更换外固定针治愈,无继发骨感染发生.3例出现外固定针松动,随后给予更换外固定针治疗.结论 Ilizarov骨延长和骨搬移技术在治疗下肢长骨创伤后慢性骨髓炎中有其优越性,但术后需要积极的康复治疗,预防关节功能障碍、针道感染、外固定针松动等并发症的发生.%Objective To investigate the therapeutic effect of chronic posttraumatic osteomyelitis of lower-extremity long bones treated by bone lengthening and bone transport with the Ilizarov method.Methods From January 2005 to December 2012,42 cases of chronic posttraumatic osteomyelitis of lower-extremity long bones were treated using Ilizarov bone lengthening and bone transport technique,including 13 cases of femur infection and 29 cases of tibia infection.Thirty cases were treated by debridement,compression of the fracture end and bone lengthening and 12 cases by debridement and bone transport.Results All the patients received a follow-up of 12 to 48 months [(15.0 ± 4.5) months].Infection obtained one-stage control in 38 cases,but the infection was not controlled in 4 cases until 1-3 more debridement.For the 30 cases undergoing compression-distraction,26 healed in one-stage and 4 nonunion healed after additional autogenous bone grafting.Twelve cases treated by bone transport healed after additional surgery of fracture gap cleaning and autogenous bone grafting.Length of bone lengthening was 2.5-11.0 cm (mean,4.5 cm).After bone healing,shortening of the lower limb compared to the normal side was less than 2.5 cm in 36 cases,2.5-3.0 cm in 4 cases,and 3.0-4.5 cm in 2 cases.Eight cases were detected with pin-tract infection,but healed by drainage or replacement of external fixation pins.There was no further bone infection.Three cases had loosening of external fixation pin and the pins were replaced.Conclusion Ilizarov bone lengthening and bone transport technique have advantages in the treatment of chronic posttraumatic osteomyelitis of lower-extremity long bones,but postoperative active rehabilitation and close observation are needed to prevent complications of joint dysfunctions,pin tract infection and pin loosening.