摘要
[目的]比较骨搬运与包裹植骨治疗单纯胫骨大段骨缺损的效果。[方法]回顾性分析2009年1月～2016年12月80例皮肤条件相对良好的胫骨骨缺损>5 cm患者。按修复骨缺损方法不同分为骨搬运组(49例)和包裹植骨组(31例)。两组患者在年龄、性别、缺损原因、缺损距离骨修复时间和合并伤方面比较,差异均无统计学意义(P>0.05)。比较两组下地时间、负重时间、骨不连、骨愈合时间、并发症、骨缺损修复手术费用和末次随访患肢邻近关节功能恢复(Johner-Wruhs评价方法)等情况。[结果]骨搬运组与包裹植骨组在卧床时间[(23.36±6.72) d vs(27.26±12.21) d,P>0.05]、负重行走时间[(95.98±15.67) d vs (102.55±17.54) d,P>0.05]的差异无统计学意义。但是,骨搬运组的骨不连发生率显著高于包裹植骨组,差异有统计学意义[(18/49) vs (1/31),P<0.05],对骨不连者行二次手术清创植骨内固定,二次术后均达到骨性愈合。骨搬运组的骨愈合时间显著长于包裹植骨组,差异有统计学意义[(11.10±3.44)个月vs (7.77±1.67)个月,P<0.05]。此外,骨搬运组的治疗费用显著高于包裹植骨组,差异有统计学意义[(7.66±2.05)万元vs (4.46±1.20)万元,P<0.05]。末次随访时,两组患者Johner-Wruhs评定的临床效果差异无统计学意义(P>0.05)。[结论]对于单纯胫骨大段骨缺损,骨搬运和包裹植骨均是有效方法,但包裹植骨在骨愈合效果、治疗费用和并发症方面优于骨搬运。
[Objective] To compare the clinical outcomes of Ilizarov bone transport versus wrapped bone grafting for simple large segmental tibial defects. [Methods] A retrospective study was done on 80 patients who underwent surgical treatment for tibial defects more than 5 cm in length with relatively good soft tissue conditions from January 2009 to December 2016. In term of the techniques used for repairing bone defects, 49 patients underwent bone transport, while the remaining 31 patients received wrapped bone grafting. There were no significant differences in age, sex, cause of bone defects, the time elapsed from defects to repairing operation and accompanied injuries between the two groups before operation（P〈0.05）. The bed rest time,weight-bear ambulation time, medical fees, bone healing time and complications after operation were compared between them.At the latest follow up, the clinical consequences were evaluated using Johner-Wruhs criteria. [Results] There were no statistically significant differences between the two groups regarding to bed rest time [（23.36±6.72） d versus（27.26±12.21） d, P〈0.05], weight-bear ambulation time [（95.98±15.67） d versus（102.55±17.54） d, P〈0.05]. However, the bone transport group took statistically higher nonunion rate than the bone grafting group [（18/49） versus（1/31）, P〈0.05], which got bony healing after secondary surgery with bone autografting and internal fixation. Therefore, the former consumed statistically longer bone healing time than the latter [（11.10±3.44） months versus（7.77±1.67） months, P〈0.05]. In addition, the bone transport group spent statistically higher medical fees than the bone grafting group [（7.66±2.05） ten thousands of Yuan versus（4.46±1.20） ten thousands of Yuan, P〈0.05]. Nevertheless, there was no a statistical difference between the two groups in clinical consequences graded by Johner-Wruhs criteria at the latest follow up（P〈0.05）. [Conclusion] For simple large segmental tibial defects, both bone transport and wrapped bone grafting are effective treatment. By contrast, the wrapped bone grafting is superior to the bone transport in terms of bone healing, medical fees and complications.
作者
刘剑
周子红
刘宇
冯德宏
王建兵
LIU Jian;ZHOU Zi-hong;LIU Ya;FENG De-hong;WANG Jian-bing(Department of Orthopaedics,Orthopaedic Hospital of Wuxi City,Wuxi 214000,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2018年第20期1856-1861,共6页
Orthopedic Journal of China
基金
无锡市课题(编号:T201641)
