Ilizarov骨搬移技术治疗胫骨大段骨缺损合并软组织缺损韩立仁穆卫东陈志强张东东韩士章[摘要]目的探讨Ilizarov技术Ⅰ期治疗胫骨大段骨缺损合并软组织缺损的可行性。方法2003年9月-2010年9月收治胫骨大段骨缺损合并软组织缺损患者24例，均为胫骨开放性骨折（GustiloⅢB型20例，GustiloⅢC型4例）。在患肢上安放Ilizarov外固定架。清创术后小腿胫前内侧软组织缺损10cm×6cm，胫骨骨缺损(8±4)cm。对15例胫骨骨缺损＜5cm的患者使用Ⅰ期清创、腓骨截骨、胫骨缺损端加压。对9例胫骨缺损＞5cm的患者采用Ⅰ期清创、骨运输-骨延长。对15例患者采用Ⅰ期清创，封闭创面或缩小创面、骨搬移，Ⅱ期清理皮肤嵌顿及清理骨折端。结果所有患者随访10～24个月，平均14个月。骨缺损均得以重建，患肢肢体长度与健侧之差＜2cm，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。19例未通过额外手术进行修复。3例通过游离皮片植皮成活，2例通过局部旋转皮瓣修复覆盖创面。结论Ⅰ期使用Ilizarov外固定架进行骨搬移肢体是治疗胫骨骨缺损合并软组织缺损的有效方法。骨缺损；外固定；Ilizarov技术；胫骨IlizarovtechniquefortreatmentoflargetibiabonedefectcombinedwithsofttissuedefectHANLi-renMUWei-dongCHENZhi-qiangZHANGdong-dongHANShi-zhangDepartmentofOrthopedics,People'sHospitalofLiaocheng,Shandong252000,China[Abstract]ObjectiveToexplorethefeasibilityofIlizarovtechniqueinmanaginglargetibiadefectscombinedwithsofttissuedefects.MethodsAtotalof24patientswithlargetibialdefectscombinedwithsofttissuedefectscausedbycompoundopentibialfractureswerefixedwithIlizarovtechniquefromSeptember2003toSeptember2010.Allpatientsbelongedtoopentibialfractures,including20patientswithGustilotypeⅢBandfourwithGustilotypeⅢC.Afterdebridement,thesofttissuedefectareaswas10cm×6cmandthebonedefectwas(8±4)cm.Fifteenpatientswithtibialdefects＜5cmweretreatedwithonestagedebridement,fibularesectionandtibialdefectendcompression.Theotherninepatientswithtibialdefect＞5cmweremanagedbyonestagedebridement,bonetransportandbonelengthening.Then,15patientsweretreatedwithonestagedebridement,woundclosureorwoundreduction,bonegraftingtreatmentandsecondstagecleansingoftheincarceratedskinandfractureend.ResultsAllpatientswerefollowedupforaverage14months(10-24months),whichshowedreconstructionofthebonedefects,restorationofthelimblength,fracturehealingandlessthan2cmdifferencebetweenhealthlimbandcontralaterallimb.Onepatientexperiencedcommonperonealnervepalsyafteroperation,butrecoveredthreemonthslater.Ofall,19patientsrecoveredwithoutextrasurgery,threerestoredwithskingraftandtworeceivedskinflap.ConclusionIlizarovtechniqueisaneffectiveoptionfortreatingthetibialdefectscombinedwithsofttissuedefectsatonestage.Bonedefect;Externalfixation;Ilizarovtechnique;Tibia10.3760/cma.j.issn.1001-8050.2011.10.013252000聊城市人民医院骨科（韩立仁、陈志强、韩士章）超声科（张东东）山东大学附属省立医院骨科（穆卫东）万方数据2结果万方数据3讨论万方数据@@[1]RobertRS,WeitznanAM,TraceyWJ,etal.Simultaneoustreatmentoftibialboneandsoft-tissuedefectswiththeIlizarovmethod.JOrthopTrauma,2006,20(3):197-205.@@[2]张志刚，王宇，李海，等.应用骨输送与筋膜皮瓣一期修复下肢大段（块）骨软组织缺损.中国矫形外科杂志，2007,15(8)：573-576.@@[3]刘新江.胫骨平台骨折合并软组织和韧带损伤的治疗.实用诊断与治疗杂志，2006，20(6)：453-455.@@[4]张长江，任文杰，王明君，等.收集开髓扩髓自体松质骨骨碎屑植骨治疗胫骨骨折骨不连.实用诊断与治疗杂志，2006，20(11)：834-836.@@[5]IlizarovGA.Thetensionstresseffectonthegenesisandgrowthoftissue.JClinOrthop,1989,20(5):238-249.@@[6]FliemingB,PaleyD,KristiansenT,etal.AbiomechanicalanalysisoftheIlizarovexternalfixator.JClinOrthop,1989,23(9):241-295.@@[7]YangL,NayagamS,SalehM.Stiffnesscharacteristicsandinterfragmentarydisplacementswithdifferenthybridexternalfixactors.JBiomech,2003,18(2):166-172.2011-03-27编者万方数据
