环形外固定架截骨延长结合带蒂皮瓣一期治疗胫骨骨髓炎.docVIP

环形外固定架截骨延长结合带蒂皮瓣一期治疗胫骨骨髓炎 　　作者：赵玉洁1,2，任志勇2△，王 辉2 作者单位：1 261042 山东潍坊，潍坊医学院(研究生)　2 261021 山东潍坊，解放军第89医院(△通讯作者) 　　【摘要】 目的 探讨一期应用环形外固定架截骨延长结合带蒂皮瓣治疗胫骨骨髓炎并复合组织缺损的手术方法及其临床效果。方法 彻底清创后，切取带蒂皮瓣转移修复创面，一期应用环形外固定架加压固定胫骨，并于小腿近侧干骺端水平截骨，术后每天延长1mm，直至骨段相互接触愈合。结果 2005年9月-2009年12月所治疗22例患者均手术顺利，骨髓炎得到有效控制，术后随访6个月～3年，创面一期修复，原感染骨切除处及骨延长处骨性愈合，炎症未再复发。患肢经延长后恢复到正常长度，仅有2例患者因跟腱挛缩出现不同程度的足下垂畸形。结论 小腿截骨骨延长结合带蒂皮瓣对于一期治疗胫骨骨髓炎并复合组织缺损治疗效果良好。 　　【关键词】 胫骨;环形外固定架;皮瓣;骨缺损;骨延长 　　Treatment of tibial osteomyelitis by distraction osteogenesis affiliated by circular external fixator combined with pedicled flap in one stage 　　ZHAO Yu-jie，REN Zhi-yong，WANG Hui.Medical College of Weifang，Weifang 261042，China 　　[Abstract] Objective To evaluate clinical effects of treatment of tibial osteomyelitis by distraction osteogenesis affiliated by circular external fixator combined with pedicled flap in one stage.Methods Debridement was done first，then soft tissue was repaired with pedicle flap and osteotomy was done at the level of the proximal metaphysis of tibia.The fractures were fixed with circular external fixator with certain pressure and the tibia were extended 1mm per day until the bone segments contacted with each other.Results September 2005 to December 2009,22 patients were treated with this method.All of them went well and the osteomyelitis was effectively controlled.The patients were followed up 6 months to 3 years.The wounds and the fractures healed well.No inflammation recured.The involved limbs got normal length after extending.Only 2 cases occurred foot ptosis due to Achilled tendon contracture.Conclusion Distraction osteogenesis affiliated by circular external fixator combined with pedicled flap in one stage was an effective way for treatment of tibial osteomyelitis combined with soft tissue defect. 　　[Key words] tibia;circular external fixator;pedicled flap;bone defect;distraction osteogenesis 　　胫腓骨开放性粉碎性骨折后，因创口内污染严重，清创不彻底，加之胫骨中下段血供差，术后常造成软组织及骨质同时缺损，骨髓炎及骨外露等并发症，不少患者经内固定、外固定、置管冲洗等