摘要目的 观察一期节段性清创骨搬运技术治疗胫骨感染性骨不连的治疗效果的.方法 回顾性分析2008年8月至2011年8月采用一期节段性清创骨搬运技术并创面开放治疗的15例胫骨感染性骨不连患者资料,男12例,女3例;平均年龄为36.9岁(20～55岁).患者采用局部节段性切除同时胫骨近侧干骺端截骨骨搬运及创面开放、停泊点清理植骨加压外固定支架调整等治疗,治疗过程分为4期:Ⅰ期:患者入组至初次手术前;Ⅱ期:初次手术骨搬运至停泊点;Ⅲ期:处理停泊点至拆外固定支架前;Ⅳ期:拆除外固定支架至术后2年.在4个治疗时期分别记录并发症、SF-36躯体综合功能评分(PCS)及心理综合评分(MCS)、行走时疼痛视觉模拟评分(VAS).计算愈合指数并统计治疗过程中患者的手术次数. 结果 15例患者中1例随访至拆除外固定支架,14例(93％)患者随访至拆除外固定支架2年后.15例患者胫骨病灶处节段性切除后平均缺损长度为7.5 cm(3 ～12 cm).平均愈合指数为43.1 d/cm(33 ～62 d/cm).手术治疗时间平均为48周(30 ～ 62周).与Ⅰ期PCS评分、MCS评分和VAS评分比较,Ⅱ期、Ⅲ期较低,Ⅳ期较高,差异均有统计学意义(P＜0.05);与Ⅳ期PCS评分、MCS评分和VAS评分比较,Ⅱ期、Ⅲ期较低,差异均有统计学意义(P＜0.05).15例患者共接受了23次手术,平均为1.5次/例. 结论 一期节段性清创骨搬运技术治疗胫骨感染性骨不连,虽然治疗过程较长,并发症多,但可取得躯体及心理社会功能的恢复,具有手术次数少、带架时间短等优势,可彻底治愈骨感染.

abstractsObjective To observe the clinical outcomes of primary segmental debridement and bone transport in the treatment of tibial infective nonunion.Methods From August 2008 to August 2011,we used primary segmental debridement and bone transport to treat 15 patients with tibial infective nonunion.They were 12 males and 3 females,with an average age of 36.9 years (from 20 to 55 years).Treatment procedures included segmental resection of the infection site,proximal tibial metaphyseal osteotomy,bone transport,opening infected wounds,bone graft and debridement for docking site.We divided the treatment process into 4 stages:stage Ⅰ (from admission till the primary operation),stage Ⅱ (from bone transport till the gap disappeared),stage Ⅲ (from docking site manoeuvre till removal of the external fixator),and stage Ⅳ (from removal of the external fixator till 2 years postoperation).Complications during the follow-up were recorded.Scores of physical component summary (PCS) and mental component summary (MCS) in SF-36 and the visual analogue scale (VAS) were recorded during the 4 stages.Bone healing index and surgical frequency were calculated for each patient.Results Of all the patients,one was followed up until removal of the external fixator,and 14 of them (93％) until 2 years after removal of the external fixator.After debridement the tibial defects averaged 7.5 cm(from 3 to 12cm).The healing index was 43.1 d/cm (from 33 to 62 d/cm).The surgical treatment time averaged 48 weeks (from 30 to 62 weeks).The PCS,MCS and VAS scores of stage Ⅰ were significantly higher than those of stages Ⅱ & Ⅲ but significantly lower than those of stage Ⅳ (P ＜ 0.05);the PCS,MCS and VAS scores of stage Ⅳ were significantly higher than those of stages Ⅱ & Ⅲ (P ＜ 0.05).The 15 patients received a total of 23 operations,averaging 1.5 times per patient.Conclusions Although primary segmental debridement and bone transport is a time-consuming treatment of tibial infective nonunion which may lead to many complications,it can restore physical function and psychosocial health.In addition,the treatment has advantages of limited operation frequency,short fixation time and radical control of bone infection.