动态压应力重建外固定技术免植骨治疗超大段胫骨缺损..docVIP

动态压应力重建外固定技术免植骨治疗超大段胫骨缺损 　　【摘要】 目的：观察分析采用重建外固定技术动态加压免植骨治疗超大段骨缺损的临床效果。方法：22例骨缺损长度超过15 cm的胫骨骨缺损，断端彻底清创，清除硬化骨质，采用Ilizarov重建外固定技术，干骺端截骨，通过骨运输修复骨缺损，断端会师对接后对接点动态加压，以期通过压应力成骨方式获得骨愈合。采用Ilizarov技术研究应用学会（ASAMI）骨及功能评分进行评价。结果：所有病例获得了14～23个月的随访，平均17.6个月，骨缺损断端均骨性愈合，恢复下肢负重行走功能，ASAMI优良等级，20例未植骨获得了骨性愈合，2例重吸烟史合并糖尿病患者通过植骨获得骨愈合，未植骨愈合率为90.9%。22例病例均出现针孔钉孔渗出红肿等炎症反应，局部处理后愈合，未影响骨段滑移及骨愈合。结论：Ilizarov骨运输技术可有效修复超大段骨缺损，通过对接点加压可免植骨获得骨愈合效果可靠 【关键词】 Ilizarov技术； 骨运输； 骨缺损； 植骨 【Abstract】 Objective：To observe and analyze the clinical effect of the reconstruction of external fixation technique for the treatment of large segmental bone defect.Method：22 cases with bone defect length more than 15 cm of the tibia bone defect，broken end thoroughly debridement， removal of bone sclerosis，the Ilizarov，fixation，metaphyseal osteotomy， bone transport through the repair of bone defect， the pressure on the dynamic contact ends of rendezvous docking， the compressive stress of osteoblasts obtained bone healing.The outcome were evaluated by using Association for the Study and Application of Methods of Ilizarov（ASAMI） scoring systeme.Result：All cases were followed up for 14-23 months，average 17.6 months.The bone defects were healed，the recovery of walking function of lower limb， the good grade of ASAMI.Bone healing was achieved in 20 cases without bone grafting，2 cases with severe smoking history and diabetes were treated with bone graft，and the rate of bone healing was 90.9%.In 22 cases，the inflammatory reaction， such as inflammation reaction， local treatment， and bone fracture healing were not affected by local treatment.Conclusion：Ilizarov bone transport technology can effectively repair large segmental bone defect， the contact pressure can obtain bone graft bone healing effect is reliable. 【Key words】 Ilizarov technology； Bone transportation； Bone defect； Bone graft First authors adress：The Wendeng Osteopath Hospital of Shandong Province，Weihai 264400，China doi：10.3969/j.issn.1674-4985.2016.30.011 缺损