【摘要】：目的隨著時代的不斷進步,高能量創(chuàng)傷導致的脛骨大段骨缺損成為骨科臨床醫(yī)生面臨的難題。20世紀50年代,前蘇聯科學家Ilizarov發(fā)明環(huán)形骨外固定器,并通過大量的臨床實踐及科研研究形成了張力-應力法則,再次于70年代獨創(chuàng)骨搬移技術。通過國內外的臨床實踐研究,Ilizarov骨段滑移術可以有效地治愈脛骨大段骨缺損。而影響Ilizarov骨段滑移術治療脛骨大段骨缺損療效的相關因素報道較少。本課題對應用Ilizarov技術骨段滑移治療脛骨大段骨缺損在6~10cm范圍內的病例回顧性分析和歸納總結。探討脛骨大段骨缺損行Ilizarov技術骨段滑移術的治療效果及相關因素分析指導臨床工作。方法對2008年1月~2014年6月,收治63例脛骨大段骨缺損患者進行回顧性分析:應用Ilizarov技術骨段滑移治療脛骨上段骨缺損28例為A組,應用Ilizarov技術骨段滑移治療下段骨缺損35例為B組。對A、B兩組病例相關變量分析,對年齡、性別、骨缺損幅度、截骨平面以及對A、B兩組去除外固定架后1個月、2個月、3個月、6個月進行小腿功能即膝、踝關節(jié)功能進行評定及統(tǒng)計學分析。結果63例患者術后平均隨訪15~24個月,脛骨骨缺損平均長度6cm~10cm,延長天數100天~150天,拆外固定架時間8個月~12個月,愈合指數35~41天/cm,所有骨缺損均愈合,愈合時間為7個月~23個月。所有患者骨缺損均達到愈合,患者去除環(huán)式外固定架后膝、踝關節(jié)功能明顯恢復。結論1 Ilizarov技術骨段滑移治療脛骨大段骨缺損術后效果顯著。2大段脛骨骨缺損的患者經Ilizarov技術骨段滑移后撤除環(huán)式外固定架,通過功能鍛煉可以恢復到與患者健側小腿正�；顒庸δ軣o明顯區(qū)別。3 Ilizarov技術骨段滑移治療脛骨大段骨缺損后,骨缺損幅度越大去除外固定架后膝、踝關節(jié)功能越差。4 Ilizarov技術骨段滑移治療脛骨大段骨缺損后,年齡越大去除外固定架后膝、踝關節(jié)功能越差。5 Ilizarov技術骨段滑移治療脛骨骨缺損截骨平面在脛骨下段比在脛骨上段術后膝、踝關節(jié)功能恢復差。
[Abstract]:Objective with the development of the times, the defect of large segment of tibia caused by high energy trauma has become a difficult problem for orthopedic clinicians. In the 1950s, Ilizarov, a former Soviet scientist, invented the ring bone external fixator. The tension-stress rule was formed through a lot of clinical practice and scientific research. According to the clinical research at home and abroad, Ilizarov segmental slippage can effectively cure the large tibial bone defect. However, the related factors affecting the treatment of large tibial bone defect with Ilizarov segmental slippage were less reported. In this study, we retrospectively analyzed and summarized the cases of large tibial bone defect treated by Ilizarov technique in the range of 6~10cm. Objective: to investigate the effect of Ilizarov technique in the treatment of large tibial bone defect and related factor analysis to guide clinical work. Methods from January 2008 to June 2014, 63 patients with large tibial bone defects were retrospectively analyzed. 28 patients with upper tibial bone defects were treated with Ilizarov technique. 35 cases of lower bone defect were treated with Ilizarov technique. The related variables were analyzed in two groups: age, sex, extent of bone defect, osteotomy level and knee function of calf after removal of external fixator for 1 month, 2 months, 3 months and 6 months after removal of external fixator in group A and B, respectively. Ankle function was evaluated and statistically analyzed. Results 63 patients were followed up for an average of 15 ~ 24 months, the average length of tibial bone defect was 6 cm / 10 cm, the lengthening time was 100 ~ 150 days, the time of removing external fixator was 8 months ~ 12 months, and the healing index was 3541 days / cm,. The healing time ranged from 7 months to 23 months. The bone defect of all the patients was healed, the knee was removed from the ring external fixator, and the ankle function was obviously restored. Conclusion (1) the effect of Ilizarov technique on the treatment of large tibial bone defect is remarkable. 2 the patients with large tibial bone defect were removed the ring external fixator after Ilizarov technique. There was no significant difference between the normal activity function of the leg and that of the normal leg by functional exercise. (3) after the large tibial bone defect was treated with Ilizarov technique, the greater the extent of bone defect was, the greater the removal of the external fixator and the knee. The worse the function of ankle joint was. 4 after the treatment of large tibial bone defect with Ilizarov technique, the older the knee was, the older the external fixator was removed. The lower the function of ankle joint, the worse the functional recovery of ankle joint was. 5. The level of osteotomy in the lower tibia was lower than that in the upper tibia.
【學位授予單位】：華北理工大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3

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