摘要目的 探讨Ilizarov技术治疗合并软组织损伤的胫骨缺损的手术策略与临床疗效.方法 回顾性分析2010年5月至2015年2月收治的52例合并软组织损伤的胫骨缺损患者资料,男41例,女11例;年龄19～65岁,平均37.7岁;损伤按照Gustilo分型:ⅢB型49例,ⅢC型3例;软组织缺损面积7cm×3cm～28cm×15cm;胫骨干缺损长度5～15 cm,平均12.6 cm.根据胫骨骨与软组织缺损部位及创面大小选择Ilizarov技术的3种不同治疗方案:创面开放换药结合骨搬运术治疗21例,肢体短缩后骨折端加压骨延长术治疗12例,组织瓣移植结合骨搬运术或骨延长术治疗19例. 结果 所有患者术后获13 ～61个月(平均27.1个月)随访,骨搬运或延长距离5.0～13.6cm(平均10.8 cm);平均骨搬运速度0.81 mm/d.52例患者胫骨全部愈合,外固定时间13 ～21个月,平均15.3个月,外固定指数2.3个月/cm.根据Paley评分标准评价功能:优23例,良19例,可9例,差1例,优良率为80.7％.结论 根据小腿骨与软组织缺损部位和程度合理选择Ilizarov技术的3种方案可取得较好的临床效果.

abstractsObjective To report our clinical outcomes of treating tibial defects combined with soft tissue defects using Ilizarov technique.Methods From May 2010 to February 2015,52 patients with combined bone and soft tissue defects of the tibia were treated at our department.They were 41 males and 11 females,aged from 19 to 65 years (average,37.7 years).By Gustilo classification,49 cases were type ⅢB and 3 type ⅢC.The areas of soft tissue defect ranged from 7 cm ×3 cm to 28 cm × 15 cm,and the tibial defects ranged from 5 cm to 15 cm in length (average,12.6 cm).The schemes of Ilizarov technique depended on the location and size of the tibial defects.Open wound dressing combined with bone transport was adopted in 21 cases,limb shortening followed by bone lengthening with compression at the fracture ends in 12 cases,and tissue flap transplantation combined with bone transport or lengthening in 19 cases.Results The follow-up time of the 52 patients ranged from 13 to 61 months (average,27.1 months).The distance of bone transport or lengthening ranged from 5.0 cm to 13.6 cm (average,10.8 cm);the bone transport speed averaged 0.81 mm/day.The tibiae united in all the 52 patients;the time for external fixation ranged from 13 to 21 months (average,15.3 months);the external fixation index was 2.3 months/cm.According to the Paley functional criteria,23 cases were excellent,19 good,9 fair,and one poor,yielding an excellent to good rate of 80.7％.Conclusion According to the location and size of the bone and soft tissue defects of the tibia,the 3 schemes of Ilizarov technique can be rationally chosen to obtain fine clinical outcomes.