中国组织工程研究

中国组织工程研究 ›› 2022, Vol. 26 ›› Issue (12): 1849-1853.doi: 10.12307/2022.506

• 骨科植入物 orthopedic implant • 上一篇    下一篇

单平面截骨骨搬移联合髓内钉治疗胫骨骨缺损

涂振兴1，2，王  斌2，卢爱东3，张顶顶1，杨焕友2，王  辉2，王  伟2，宫中平2，李力更2   

  1. 1华北理工大学研究生学院，河北省唐山市   063000；2唐山市第二医院手外科、修复重建外科、下肢血管病科，河北省唐山市   063000；3开滦总医院，河北省唐山市   063000
  • 收稿日期:2021-07-14 修回日期:2021-07-15 接受日期:2021-08-30 出版日期:2022-04-28 发布日期:2021-12-14
  • 通讯作者: 王斌，主任医师，唐山市第二医院手外科、修复重建外科、下肢血管病科，河北省唐山市 063000
  • 作者简介:涂振兴，男，1993年生，福建省泉州市人，汉族，硕士，医师，主要从事肢体重建研究。

Single-level osteotomy and bone transfer combined with intramedullary nail in the treatment of tibial bone defect

Tu Zhenxing1, 2, Wang Bin2, Lu Aidong3, Zhang Dingding1, Yang Huanyou2, Wang Hui2, Wang Wei2, Gong Zhongping2, Li Ligeng2   

  1. 1Graduate School of North China University of Science and Technology, Tangshan 063000, Hebei Province, China; 2Department of Hand Surgery, Repair and Reconstruction Surgery, Lower limb Vascular Disease, Tangshan Second Hospital, Tangshan 063000, Hebei Province, China; 3Kailuan General Hospital, Tangshan 063000, Hebei Province, China
  • Received:2021-07-14 Revised:2021-07-15 Accepted:2021-08-30 Online:2022-04-28 Published:2021-12-14
  • Contact: Wang Bin, Chief physician, Department of Hand Surgery, Repair and Reconstruction Surgery, Lower limb Vascular Disease, Tangshan Second Hospital, Tangshan 063000, Hebei Province, China
  • About author:Tu Zhenxing, Master, Physician, Graduate School of North China University of Science and Technology, Tangshan 063000, Hebei Province, China; Department of Hand Surgery, Repair and Reconstruction Surgery, Lower limb Vascular Disease, Tangshan Second Hospital, Tangshan 063000, Hebei Province, China

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摘要：

文题释义：
骨搬移：该技术是治疗大段骨缺失的常用技术之一，通过运用牵张应力法则缓慢滑动骨块，治疗骨缺损。
Ilizarov技术张力-应力法则：生物组织被缓慢牵拉时会产生一定的张力，可刺激组织再生和活跃生长，其生长方式如同胎儿组织一样是细胞分裂。人的骨骼和人体上皮组织、结缔组织一样，具有很大的再生潜力和可塑性，给骨骼一个合适的应力性牵拉，骨骼及其附着的肌肉、筋膜、血管、神经就会同步生长。通过Ilizarov外固定器安装在患肢上实施矫正治疗的一项牵拉成骨技术(牵拉组织再生技术)，也是当今世界最先进的骨科矫形技术。

背景：骨搬移是治疗各种原因导致的骨缺损的有效手段，但外固定架佩戴时间长、延长骨长度丢失、弯曲畸形等并发症的存在限制了其应用。
目的：探索单平面截骨骨搬移联合髓内钉与单纯单平面截骨治疗胫骨骨缺损的疗效差异。
方法：选择2011年1月至2018年4月唐山市第二医院收治的胫骨骨缺损患者，纳入15例进行单平面截骨骨搬移联合髓内钉治疗的患者(试验组)与30例进行单纯单平面截骨骨搬移治疗的患者(对照组)。治疗后以门诊随诊、电话、微信视频相结合的方式进行随访，比较两组患者再生区矿化时间、愈合指数、外固定时间、外固定指数、对接点愈合情况、针道感染、再骨折等情况，采用Ilizarov方法研究与应用学会(ASAMI)评分标准进行骨愈合和功能评价。
结果与结论：①两组患者获得(31.0±7.3)个月随访，拆除外架后切口无红肿、疼痛，针道感染均被控制；②两组患者再生区矿化时间、愈合指数、再骨折率和对接点愈合情况比较差异均无显著性意义(P > 0.05)，试验组外固定指数小于对照组(P < 0.05)，进行清理骨端、植骨的患者数量少于对照组(P < 0.05)，针道感染发生率低于对照组(P < 0.05)；③试验组患者ASAMI骨愈合与功能评分均优于对照组(P < 0.05)；④结果表明，与单平面截骨骨搬移比较，单平面截骨骨搬移联合髓内钉治疗胫骨骨缺损可缩短带架时间、降低术后清理骨端再植骨加压的概率、避免针道感染。

https://orcid.org/0000-0002-1290-4918 (涂振兴) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 髓内钉, 骨搬移, Ilizarov技术, 胫骨骨缺损, 环形外固定架, 愈合指数, 外固定指数, 对接点

Abstract: BACKGROUND: Bone transfer is an effective treatment of bone defect caused by various causes. However, the complications, such as long wearing time of the external fixator, the loss of extended bone length, and bending deformities, restrict its application.  
OBJECTIVE: To explore the difference in the efficacy of single-level osteotomy combined with intramedullary nail and single-level osteotomy in the treatment of tibial bone defect.
METHODS:  Patients with tibial bone defect were selected from Tangshan Second Hospital from January 2011 to April 2018. Fifteen patients treated with single-level osteotomy and bone transfer combined with intramedullary nail were used as the trial group. Thirty patients treated with single-level osteotomy and bone transfer were used as the control group. After treatment, follow-up was carried out by the combination of outpatient follow-up, phone call and Wechat video. The mineralization time of regeneration area, healing index, external fixation time, external fixation index, joint healing, needle infection, and refracture were compared between the two groups. The scoring standard of Association of Study and Application on Method of Ilizarov was used to evaluate the bone healing and function.  
RESULTS AND CONCLUSION: (1) The patients in both groups were followed up for (31.0±7.3) months. The incision had no redness, swelling, or pain, and needle tract infection were controlled after removal of the outer frame. (2) There was no significant difference in mineralization time, healing index, refracture rate, and joint healing between the two groups (P > 0.05). The external fixation index was smaller in the trial group than that in the control group (P < 0.05). Number of patients with bone end cleaning and bone grafting was smaller in the trial group than that in the control group (P < 0.05). The rate of needle tract infection was lower in the trial group than that in the control group (P < 0.05). (3) ASAMI score was better in the trial group than that in the control group (P < 0.05). (4) It is concluded that compared with the single-level osteotomy and bone transfer, single-level osteotomy and bone transfer combined with intramedullary nail in the treatment of tibial bone defect can shorten the fixator time, reduce the probability of postoperative debridement and replantation of bone compression, and avoid needle tract infection.

Key words: intramedullary nail, bone transfer, Ilizarov technique, tibial bone defect, circular external fixator, healing index, external fixation index, docking site

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