Wang Xing-Guo, Wang Wei, Wang Xing-Yi, Lü Lei, Wang Gong-Qi, Ma Qing-Song, Su Gui-You
The Osteomyelitis Hospital of Beijing, Beijing 102206, China.
Zhongguo Gu Shang. 2010 Jun;23(6):422-5.
To explore the therapeutic effectiveness of Ilizarov technique in treatment of infected tibial defects combined with overlaying skin defects.
Twenty-one cases with infected tibial defects combined with skin defects were treated between 2001 and 2008 includeing 18 males and 3 females with an average age of 31 years ranging from 19 to 43 years. The length of bone defect ranged from 3 to 13 cm (means 6 cm). Skin defect area was from 3 cm x 3 cm to 6 cm x 10 cm; 11 cases combined with drop foot, 5 cases with arthrocleisis of knee. Preoperative X-ray of the affected limb was performed and zone of skin necrosis was marked, then the point and length of osteotomized bone, and scope of bone and soft tissue need for removing were determined. The internal fixation were removed. Opening irrigation, vacuum sealing drainage (VSD), and dressing changing were appllied. The skin was fixed with Kirschner wire and bone was transferred with Ilizarov technique in all patients. The lengthening of bone and skin was carried out for 4 to 7 days after surgery, 1/6 to 1/4 mm once, 4 to 6 times a day. The clinical effectiveness was determined mainly through wound and lengthening of skin.
All patients were followed up for from 6 to 62 months (means 49.5 months). Fourteen of 21 cases received one stage treatment, there was still secretion from end of bone in 3 patients whose bone healed after debridement, the other 4 patients were cured via trimming end of bone and compression fusion. The defects of bone were extended to full length in 18 patients. Abutting end was slightly absorbed and became rattailed in 2 cases, there was lack of blood supply to abutting ends in one patient who was cured via bone graft from iliac bone. Skin defects was cured in 18 patients with one stage treatment, the other 3 patients were cured after infection was controlled. The deformity of drop foot were corrected in 11 patients, and function of knee was improved in five patients. The external fixator was removed at 1.2 to 2.6 years after surgery. At last, bone infections were cured, defects of bone and skin recovered in all patients.
One stage treatment of infected tibial defects combined with skin defects using Ilizarov technique has minimal invasion with less complex surgeries, could reduce the time and expense of treatment.
探讨伊里扎洛夫技术治疗感染性胫骨缺损合并皮肤缺损的疗效。
2001年至2008年共治疗21例感染性胫骨缺损合并皮肤缺损患者，其中男性18例，女性3例，平均年龄31岁（19～43岁）。骨缺损长度3～13 cm（平均6 cm）。皮肤缺损面积3 cm×3 cm至6 cm×10 cm；11例合并足下垂，5例合并膝关节强直。术前对患肢行X线检查，标记皮肤坏死区域，确定截骨部位、长度及需切除的骨与软组织范围。拆除内固定。行开放冲洗、负压封闭引流（VSD）及换药。所有患者均用克氏针固定皮肤，采用伊里扎洛夫技术进行骨搬运。术后4～7天开始进行骨与皮肤延长，每次1/6～1/4 mm，每天4～6次。主要通过伤口及皮肤延长情况判断临床疗效。
所有患者随访6～62个月（平均49.5个月）。21例患者中14例行一期治疗，3例清创后骨端仍有分泌物，经再次清创后骨愈合，另4例经修整骨端及加压融合治愈。18例患者骨缺损延长至全长。2例对接端轻度吸收呈鼠尾状，1例对接端血供不足，经髂骨植骨治愈。18例患者皮肤缺损一期治愈，另3例感染控制后治愈。11例患者足下垂畸形得到纠正，5例患者膝关节功能改善。术后1.2～2.6年拆除外固定架。最终，所有患者骨感染治愈，骨与皮肤缺损恢复。
应用伊里扎洛夫技术一期治疗感染性胫骨缺损合并皮肤缺损，创伤小，手术操作相对简单，可减少治疗时间和费用。
