中国组织工程研究

中国组织工程研究 ›› 2020, Vol. 24 ›› Issue (36): 5858-5863.doi: 10.3969/j.issn.2095-4344.2905

• 骨与关节综述 bone and joint review • 上一篇    下一篇

骨搬移后对合端延迟愈合、不愈合的机制研究与规范化临床应用技术

殷海阳1，张永红2   

  1. 1山西医科大学，山西省太原市  030001；2山西医科大学第二医院骨科，山西省太原市  030001
  • 收稿日期:2020-03-16 修回日期:2020-03-21 接受日期:2020-04-22 出版日期:2020-12-28 发布日期:2020-10-27
  • 通讯作者: 张永红，博士，主任医师，国际肢体延长与重建协会及Ilizarov技术应用研究协会中国部秘书长，中国骨搬移糖尿病足学组组长，山西医科大学第二医院骨科，山西省太原市 030001
  • 作者简介:殷海阳，男，1992年生，山东省人，汉族，山西医科大学在读硕士，主要从事肢体矫形与骨感染方面的研究。
  • 基金资助:
    山西省应用基础研究计划(201901D111369)

Mechanism of delayed union and nonunion of the docking site after bone transport and standardized clinical application technology

Yin Haiyang1, Zhang Yonghong2   

  1. 1Shanxi Medical University, Taiyuan 030001, Shanxi Province, China; 2Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
  • Received:2020-03-16 Revised:2020-03-21 Accepted:2020-04-22 Online:2020-12-28 Published:2020-10-27
  • Contact: Zhang Yonghong, MD, Chief physician, Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
  • About author:Yin Haiyang, Master candidate, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
  • Supported by:
    the Shanxi Application Basic Research Plan, No. 201901D111369

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摘要：

文题释义：

对合端：骨搬移牵张期结束阶段，搬移骨段与残留目标骨端接近，两者间所形成的区域即为对合端。该区域多伴有骨折断端对合面积小、纤维组织嵌入、应力集中、局部软组织条件差等。

“手风琴”技术：是指通过调整外固定架，使搬移骨块滑动，在不愈合断端施加周期性的压缩应力及牵张应力的固定技术。

背景：骨搬移技术是治疗大段骨缺失的常用技术之一，但治疗过程中对合端延迟愈合、不愈合发生率较高，亟待解决。

目的：针对目前四肢长骨骨搬移后对合端延迟愈合、不愈合的研究报道进行综述，明确目前的治疗方法、存在的问题及下一步研究方向。

方法：检索2009年1月至2019年12月PubMed、中国知网及万方医学网数据库中关于骨搬移、对合端/对接点的相关文献，英文检索词为“docking site”“bone transport”“distraction osteogenesis”，中文检索词为对合端、对接点、骨搬移和牵拉成骨。

结果与结论：①骨搬移是治疗四肢长骨大段骨缺损尤其是合并感染情况时的金标准，对合端延迟愈合、不愈合是该技术的并发症之一，文献报道其发生率为73%，总体呈较高水平；②导致对合端延迟愈合、不愈合的原因众多，包括对位不良接触面积减小、间隙内软组织嵌顿、血液供应差等；③预防以注意术前评估、术中精确操作、术后定期复查，早期干预为主，针对其治疗方法以断端切新+植骨的手术方法为主，此外衍生出了关节镜下断端清理+植骨修复、联合钢板、髓内针等内固定及非手术治疗等方法，并可辅助体外震波治疗、电磁场刺激、高压氧疗法和基因治疗等手段；③“手风琴”技术是保守治疗的方法之一，具有创伤小、费用低、无需植骨等优点，可单独应用于对合端不愈合的治疗，然而已报道的“手风琴”操作方案不一，病例较少，且机制尚不明确，限制了该技术的进一步推广；④今后应进一步扩大临床应用研究范围并深入基础研究该技术的作用机制，优化统一操作方案，使其得到进一步推广应用。

ORCID: 0000-0002-7327-5932(殷海阳)

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: 骨, 骨搬移, Ilizarov技术, 对合端, 并发症, 骨不愈合, 延迟愈合, 植骨

Abstract:

BACKGROUND: Bone transport technology is one of the commonly used technologies for the treatment of large bone loss. However, the delayed union and nonunion rate of the docking site during the treatment is high and needs to be solved urgently.

OBJECTIVE: To summarize the current reports on delayed union and nonunion of the docking site after limb

bone transport, to clarify the current treatment methods, existing problems and future research directions.

METHODS: The PubMed, CNKI, and Wanfang Med Online Database were searched for relevant literatures on bone transport and docking site published from January 2009 to December 2019. The English and Chinese search key words were “docking site, bone transport, distraction osteogenesis”.

RESULTS AND CONCLUSION: (1) Bone transport is the gold standard for the treatment of long bone defects in the limbs, especially in the case with infection. Delayed union and nonunion of the docking site are the common complications. The incidence rate in the literature is 73%, at a high level overall. (2) There are many reasons that lead to delayed union and nonunion of the docking site, including reduction of the area of contact, incarceration of soft tissue in the gap, and poor blood supply. (3) Prevention should focus on preoperative evaluation, precise operation, regular postoperative review, and early intervention. The treatment method is mainly based on incision and bone grafting. In addition, surgery under arthroscopy, combined fixation with plates, intramedullary pins, and non-surgical treatment are derived. It can assist extracorporeal shock wave therapy, electromagnetic field stimulation, hyperbaric oxygen therapy, and gene therapy. (3) “Accordion” technique is one of the conservative treatment methods. It has the advantages of fewer traumas, low cost, and no bone grafting. However, the “accordion” technique schemes are different; there are few cases reported; and the mechanism is not clear, which limits the further promotion of the technology. (4) In the future, the clinical research should be further expanded, and the mechanism of the technology should be studied in depth. The unified operation scheme should be optimized to further promote the “accordion” technique application.

Key words: bone, bone transport, Ilizarov technique, docking site, complication, bone nonunion, delayed union, bone grafting

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