胫骨骨髓炎骨缺损骨搬移软组织并发症的处理

Management of soft tissue complications in bone transportation for tibial bone defect secondary to osteomyelitis

摘要:

[目的] 介绍胫骨骨髓炎骨缺损骨搬移软组织并发症的处理的手术技术和初步临床结果。[方法] 2017 年1 月—2022 年12 月笔者采用骨搬移治疗54 例胫骨慢性骨髓炎骨缺损。对会合端周围皮肤感染或坏死，分别采用局部清创植皮或皮瓣移植修复，或清创并皮肤牵张器牵张。对会合端软组织嵌顿采用局部软组织松解。会合端软组织嵌顿合并骨不愈合，行会合端清理植骨，更换锁定板外固定。晚期再次软组织缺损并骨外露，给予局部清创皮肤牵张。[结果] 54 例患者骨搬运长度3~14cm，外固定指数为1.2~2.5 个月/cm。30 例患者会合端顺利愈合，无软组织并发症，其余24 例出现会合端周围软组织相关并发症，占44.4%。经上述方法给予相应处理后，局部软组织并发症均有效解决。[结论] 胫骨骨髓炎骨缺损应用Ilizarov 骨搬移早期软组织再次感染、单纯软组织嵌顿、软组织嵌顿伴对合端骨不愈合、晚期再次软组织缺损并骨外露等并发症发生率较高。虽然最终均可通过后期的治疗解决相关并发症，但是明显延长治疗过程，增加患者负担，应引起骨科医生的高度重视。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results for the management of soft tissue complica-tions of in bone transportation for tibial bone defect secondary to osteomyelitis. [Methods] From January 2017 to December 2022, 54 pa-tients with chronic osteomyelitis of tibia were treated with bone transportation, with the soft tissue complication treated accordingly. The lo-cal debridement, skin grafting or skin flap transplantation, and skin stretch device were used for skin infection or necrosis around the junc-tion. Local soft tissue release was used for occlusal soft tissue incarceration, while bone grafting at the joint ends combined with replacementof plate external fixation was conducted for soft tissue incarceration at the joint end complicated with bone nonunion. In addition, local de-bridement and skin stretching were performed for late soft tissue defect with bone exposed again. [Results] The bone lengthened ranged from3 cm to 14 cm, and the external fixation index was of 1.2~2.5 months /cm in the 54 patients. Of them, 30 patients got conjunctional end heal-ing without soft tissue complications, whereas the remaining 24 patients had soft tissue related complications around the conjunctional ends,accounting for 44.4%. However, all the local soft tissue complications were solved effectively after the corresponding treatment as mentionedabove. [Conclusion] The incidence of soft tissue complications of bone transportation with Ilizarov frame for tibial bone defect secondary os-teomyelitis is high, including soft tissue reinfection in the early stage, simple soft tissue incarceration, soft tissue incarceration with bone non-union, and late soft tissue redefect with bone exposure. Although the related complications can eventually be solved through later treatment,the obvious prolongation of the treatment process and increase the burden of patients should be paid great attention to by orthopedic surgeon.