“手风琴”技术对Ilizarov骨搬运治疗骨缺损疗效的影响

doi:10.13418/j.issn.1001-165x.2021.05.018

摘要/Abstract

摘要： 目的　探讨“手风琴”技术对Ilizarov骨搬运治疗骨缺损疗效的影响。方法　回顾性分析2013年12月~2017年2月本院采用Ilizarov骨搬运技术治疗大段胫骨骨缺损的29例患者资料。随机分为两组，两组患者的性别、年龄、骨缺损长度、手术次数、骨搬运术前邻近关节评分等情况，差异均无统计学意义。观察外固定时间、骨愈合时间、骨愈合分级、术后并发症和下肢功能恢复等。结果　患者均安全度过围手术期，随访时间20~40个月，平均24.3个月。对照组（15例）骨愈合时间为（14.35±3.39）个月，“手风琴”组（14例）为（12.56±2.80）个月，两组骨愈合时间比较差异有统计学意义。对照组骨愈合分级优8例，良4例，优良率为80%；“手风琴”组优7例，良5例，优良率为85.7%，“手风琴”组好于对照组，但差异无统计学意义（P＞0.05）。“手风琴”组的并发症发生率少于对照组，差异有统计学意义（P＜0.05）。对照组下肢功能恢复分级优7例，良6例，优良率为86.7%；“手风琴”组优8例，良5例，优良率为92.8%，差异无统计学意义。对照组外固定时间为（15.15±2.86）个月，“手风琴”组为（14.09±2.23）个月，差异无统计学意义（P＞0.05）。结论　通过“手风琴”技术可以缩短对合端骨愈合时间、提高愈合率和减少并发症，对肢体功能恢复有一定的积极作用，应重视其在骨搬运技术中的重要性。

关键词: “手风琴”技术, 　骨缺损, 　骨搬运, 　胫骨

Abstract: Objective　To investigate clinical effects of ‘accordion’ technique on the treatment of large segmental tibial bone defects by Ilizarov bone transport technique.　Methods　The clinical data of 29 patients admitted to our hospital treated with large segmental tibial bone defects using Ilizarov bone transport technique were retrospectively analyzed. These patients were randomly divided into two groups. There was no statistically significant difference between the two groups in gender, age, length of bone defect, operation frequency, preoperative adjacent joint score before bone transport. External fixation time, healing time, healing grade and complications after surgery and function recovery of the lower limb were analyzed.　Results　All patients experienced no or minor complications during the perioperative period, then recovered completely. Follow up about 20~40 months, with a mean value of 24.3 months. The bone healing time of the control group was（14.35±3.39）months while that of the “accordion” group was（12.56±2.80）months , there was statistical difference in the bone healing time between the two groups. Bone healing grade in the control group: 8 cases were excellent, 4 cases good, overall good rate was 80%. Bone healing grade in the “accordion” group: 7 cases excellent, 5 cases good, overall good rate was 85.7%. Bone healing grade of “accordion” group was better than that of control group, but there was no statistical difference(P>0.05). The complication rate of “accordion” group was lower than that of the control group, there were statistical differences in the complication rate between the two groups. Lower limb function recovery in the control group: 7 cases were excellent, 6 cases good, with an overall good rate of 86.7%. While for that in the “accordion” group, 8 cases were excellent, 5 cases good, the overall good rate was 92.8%. The external fixation time of the control group was (15.15±2.86) months while that of the accordion group was (14.69±2.23) months, there was no statistical difference in the external fixation time (P>0.05).　Conclusions　“Accordion” technology can shorten the time of bone healing at the union end, improve the rate of natural healing rate and reduce complications of surgeries, which plays a positive role in the recovery of limb function.It is worthy of our attention on its application in clinical practice.

Key words: , “Accordion” technique, 　Bone defect, 　Bone transport, 　 Tibia

中图分类号:

687.3

韩晓飞, 　孙振中, 　宋升, 　刘学光, 　张树军, 　杜世浩. “手风琴”技术对Ilizarov骨搬运治疗骨缺损疗效的影响[J]. 中国临床解剖学杂志, 2021, 39(5): 598-602.

Han Xiaofei, Sun Zhenzhong, Song Sheng, Liu Xueguang, Zhang Shujun, Du Shihao. Effect of “accordion” technique on the clinical treatment of bone defect by Ilizarov bone transport[J]. Chinese Journal of Clinical Anatomy, 2021, 39(5): 598-602.

参考文献 14

[1]	尚大财, 刘钦林, 钟生财, 等. Ilizarov骨滑移技术治疗四肢长骨创伤性骨髓炎的临床研究[J]. 中国矫形外科杂志, 2016, 24(3): 220-225. DOI: 10.3977/j.issn.1005-8478.2016.03.06.
[2]	贺国宇, 张永红, 王栋, 等. Ilizarov技术治疗胫骨骨缺损的优势及改进策略[J]. 中国组织工程研究, 2020, 24(24): 3870-3876. DOI: 10.3969/j.issn.2095-4344.2752.
[3]	沈洁, 叶晓健. “手风琴”技术在牵张成骨区新生骨矿化中的作用[J]. 中华修复重建外科杂志, 2018, 32(5): 558-567. DOI: 10.7307/1892.201712094.
[4]	冯震, 张猛, 吴薇娜. “手风琴”技术治疗骨折不愈合模型兔[J]. 中国组织工程研究, 2018, 22(32): 5175-5179. DOI: 10.3969/j.issn.2095-4344.0384.
[5]	Baruah RK, Haque R. Accordion maneuver with modified llizarov frame for treatment of recalcitrant nonunion of shaft of femar in a patient with pycnodysostosis[J]. J Clin Orthop Trauma, 2016, 7(1): 45-47. DOI: 10.1016/j.jcot.2016.09.006.
[6]	沈洁, 叶晓健. “手风琴”技术在肥大性骨不连中的应用及疗效[J]. 中华创伤骨科杂志, 2018, 20(4): 318-322. DOI: 10.3760/cma.j.issn.1671-7600.2018.04.008.
[7]	卢炎君, 张永红, 王栋, 等. 手风琴技术治疗胫骨骨折延迟愈合或不愈合[J]. 中华骨科杂志, 2019, 39(1): 30-35. DOI: 10.3760/cma.j.issn.0253.2352.2019.01.005.
[8]	Xu J, Jia YC, Kang QL. Chai YM. Management of hypertrophic nonunion with failure of internal fixation by distraction osteogenesis[J]. Injury, 2015, 46(10): 2030-2035. DOI: 10.1016/j.injury.2015.06.020.
[9]	Makhdom AM. Hamdy RC. The role of growth factors on acceleration of bone regeneration during distraction osteogenesis[J]. Tissue Eng Part B Rev, 2013, 19 (5): 442-453. DOI: 10.1089/ten.teb.2012.0717.
[10]	彭瑞健, 张永红, 李晓辉, 等. 手风琴技术用于骨搬移治疗胫骨骨缺损[J]. 中国骨伤, 2018, 9(31): 824-828. DOI: 10.3969/j.issn.1003-0034.2018.09.009.
[11]	XU J, SUN Y, WU T, et al. Enhancement of bone regeneration with the accordion technique via HIF-1IIVEGF activation in a rat distraction osteogenesis model[J].Tissue Eng Regen Med, 2018, 12(2): 1268-1276. DOI: 10.1002/term.2534.
[12]	殷渠东, 顾三军, 孙振中, 等. 胫骨骨和软组织缺损三种治疗方法的效果比较[J]. 中华创伤杂志, 2015, 31(3): 245-248. DOI: 10.3760/cma.j.issn.1001-8050.2015.03.016.
[13]	Tetsworth K, Paley D, Sen C, et al. Bone transport versus acute shortening for the management of infected tibial non-unions with bone defects[J]. Injury, 2017, 48(10): 2276-2284. DOI: 10.1016/J.injury. 2017. 07.018.
[14]	胡居正, 石展英, 杨成志, 等. 骨搬移后对合端植骨内固定治疗下肢大段骨缺损的临床研究[J]. 中华骨科杂志, 2018, 38(5): 280-287. DOI: 10.3760/cma.j.issn.0253-2352.2018.05.004.