| 胫骨骨运输术中对接端新鲜化技术的临床观察 |
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投稿时间：2022-09-02
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| 作者 | Author | 单位 | Address | E-Mail |
| 滕星 |
TENG Xing |
北京积水潭医院创伤骨科, 北京 100035 |
Orthopaedic Trauma Department,Beijing Jishuitan Hospital,Beijing,100035,China |
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| 黄雷 |
HUANG Lei |
北京积水潭医院创伤骨科, 北京 100035 |
Orthopaedic Trauma Department,Beijing Jishuitan Hospital,Beijing,100035,China |
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| 杨胜松 |
YANG Sheng-song |
北京积水潭医院创伤骨科, 北京 100035 |
Orthopaedic Trauma Department,Beijing Jishuitan Hospital,Beijing,100035,China |
yangshengsongjst@qq.com |
| 王陶 |
WANG Tao |
北京积水潭医院创伤骨科, 北京 100035 |
Orthopaedic Trauma Department,Beijing Jishuitan Hospital,Beijing,100035,China |
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| 公茂琪 |
GONG Mao-qi |
北京积水潭医院创伤骨科, 北京 100035 |
Orthopaedic Trauma Department,Beijing Jishuitan Hospital,Beijing,100035,China |
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| 蒋协远 |
JIANG Xie-yuan |
北京积水潭医院创伤骨科, 北京 100035 |
Orthopaedic Trauma Department,Beijing Jishuitan Hospital,Beijing,100035,China |
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| 期刊信息：《中国骨伤》2022年，第35卷，第10期，第914-920页 |
| DOI：10.12200/j.issn.1003-0034.2022.10.003 |
| 基金项目:首都临床特色应用研究(编号:Z161100000516052) |
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中文摘要:
目的:研究胫骨骨运输术中对接端应用骨面新鲜化处理技术的效果。
方法:对2014年1月至2019年12月胫骨骨运输术中对接端骨面新鲜化处理手术的20例患者进行分析。其中男15例,女5例;年龄19~62(42.3±11.5)岁;感染性7例,非感染性13例。对接端达到接触后即刻通过使骨面新鲜化处理的手术技术,清除卡入断端的皮肤和软组织,切除硬化封闭的骨端,改善对位,增加接触面积,术中即刻对对接端进行加压,并就近取骨植骨。术后继续逐渐加压。
结果:缺损长度5~15(9.2±2.9) cm,从截骨到对接端接触需要26~243(109.1±51.1) d。所有患者对接端达到骨性愈合。达到影像学愈合标准需要3~7(3.7±1.1)个月,20例中15例需要腓骨截骨,其中14例腓骨的截骨端达到骨性愈合。胫骨牵开端的骨痂达到影像学坚实化的时间需要5~28(15.0±6.5)个月,骨愈合指数(bone healing index,BHI)为每厘米需0.8~2.8(1.6±0.5)个月。20例中1例胫骨切口出现感染。拆除外固定架后随访时间为12~73(37.6±20.3)个月,所有患者对接端未发生骨折。
结论:胫骨骨运输术中,当对接端接触后尽早进行骨面新鲜化处理能缩短对接端的愈合时间,避免对接端再骨折,术中收集的松质骨和钻孔产生的骨屑能消除缺损和间隙,避免在其他部位取自体骨植骨。 |
| 【关键词】胫骨骨运输术|对接端|Ilizarov技术|牵开成骨 |
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| Effect of freshening technique on docking site in tibial bone transport management |
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ABSTRACT
Objective: To study the effect of freshening technique on docking site in tibial bone transport management.
Methods: Retrospective cohort study was conducted about the effect of freshening technique on docking site in 20 cases(15 males and 5 females) treated with tibial bone transport from January of 2014 to December of 2019. The age of patients ranged from 19 to 62 years old,with an average of (42.3±11.5)years old. Seven patients had infectious bone defect and 13 patients had non-infectious. Application of freshening technique immediately after docking included resection of invaginated skin or soft tissue,removal of closed sclerotic bone,re-apposition,increasing the contact,acute compression of freshened docking site and grafting from adjacent medullary or bone debris,followed by post-operative gradual compression.
Results: The amount of segmented bone defect ranged from 5 to 15 cm,with an average of(9.2±2.9) cm. Time required from osteotomy to contact of butt end ranged from 26 to 243 days,with an average of(109.1±51.1) days. The duration needed from 3 to 7 months with an average of(3.7±1.1) months before reaching radiological healing criterion in docking site. Fourteen out of 15 concurrent fibular osteotomy were united. Consolidation time for distracted callus ranged from 5 to 28 months,with an average of (15.0±6.5) months. Bone healing index(BHI) ranged from 0.8 to 2.8 months/cm,with an average of (1.6±0.5) months. One surgical site infection (5%) in tibial was noted. No refractures were found in follow-up ranged from 12 to 73 months,with an average of(37.6±20.3) months after fixator removal.
Conclusion: Freshening technique immediately after docking had advantages of the shorter healing time,avoidance of refracture,and independance of necessity for remote autograft harvest. |
| KEY WORDS Tibia bone transport|Docking site|Ilizarov technique|Distraction osteogenesis |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 滕星,黄雷,杨胜松,王陶,公茂琪,蒋协远.胫骨骨运输术中对接端新鲜化技术的临床观察[J].中国骨伤,2022,35(10):914~920 |
| 英文格式: | TENG Xing,HUANG Lei,YANG Sheng-song,WANG Tao,GONG Mao-qi,JIANG Xie-yuan.Effect of freshening technique on docking site in tibial bone transport management[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(10):914~920 |
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