Ilizarov技术治疗Pilon骨折术后感染性骨坏死

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摘要目的探讨Ilizarov技术治疗Pilon骨折术后感染性骨坏死的疗效。方法回顾性分析北京昌平圣济骨伤医院2004年6月至2017年12月采用Ilizarov技术治疗Pilon骨折术后感染性骨坏死12例，其中男8例，女4例；年龄为36~69岁，平均(51±10)岁。致伤原因：交通伤8例，坠落伤4例。开放性骨折9例，闭合性骨折3例。9例患者Gustilo分型为Ⅲ型，3例患者AO分型为C型。致病菌：金黄色葡萄球菌8例(其中耐甲氧西林2例)，大肠埃希氏菌3例，铜绿假单胞菌1例。坏死骨长度为2~8 cm，平均5 cm。6例合并化脓性踝关节炎，1例距骨坏死。治疗采用坏死骨段切除，闭合式对流冲洗术、Ilizarov技术骨搬移。延长方法：骨搬移法(bone transport，BT)4例，急性短缩延长法(acute shortening distraction，ASD)3例，ASD法+BT法5例。结果 12例炎症全部治愈。胫骨和胫骨对接7例，踝关节功能良好；胫骨与距骨对接1例，胫骨和跟骨对接4例，均达到骨愈合。骨延长2~8 cm，延长段骨皮质化。全部患者均获随访，随访时间3~14年，平均随访时间(8±3)年，炎症未复发。结论 Ilizarov技术可以有效地治疗Pilon骨折术后感染性骨坏死，值得临床上进一步推广。

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关键词 ： Pilon骨折, 感染性骨坏死, Ilizarov技术, 闭合式对流冲洗术

Abstract：Objective To explore the efficacy of Ilizarov technology in treatment of infectious osteonecrosis after surgery of Pilon fracture.Methods 12 cases were selected in Beijing Changping Shengji Orthopedics Hospital from June 2004 to December 2017，these patients were diagnosed as infectious osteonecrosis after surgeryof Pilon fracture，they were treated with Ilizarov technology.There were 8 males and 4 females，with anaverage age of (51±10)years(range：36~69 year).9 patients were classified as type III by Gustilo，and 3 patients were classified as type C by AO.Pathogenic bacteria were Staphylococcus aureus(including 2 cases of MRSA)in 8 cases，E.coliin 3 cases，pseudomonas aeruginosa1 case.The length of the necrotic bone range from 2 to 8 cm，with an average length of 7 cm.6 cases suffered from uppurative arthritis of the ankle，and1 case had talus necrosis.The necrotic bone resection，closed convective irrigation，and Ilizarov's bone transport were used in these patients.BT method (bone transport，BT) wasusedin 4 cases，ASD method (acute shortening distraction，ASD) was used in 3 cases，and ASD method+BT method were usedin 5 cases.Results The inflammation of 12 cases were completely treated.The docking site of tibia and tibia occurred in 7 cases with good function of ankle joint.The docking site of tibia and talus occurred in 1 cases，the docking site of tibia and calcaneus occurred in 4 cases.All bone defect was healed.The length of bone lengthening ranges from 2~8 cm.The cortical ossification of the lengthening part was completely.The follow-up periodwas about 3~14 years and average follow-up time is (8±3)years.No osteomyelitis recurred in these patients.Conclusion Ilizarov technology can effectively treat infectious osteonecrosis after Pilon fracture，and it is worthy of further clinical promotion.

Key words： pilon fractures infectious bone necrosis ilizarov technology closed convective irrigation

通讯作者: 王华民

作者简介: 高阳(1994－ )，男，医师，新乡医学院研究生院，453000。

引用本文:

高阳 1，王伟 2，王公奇 2，王兴义 2，王华民 3*. Ilizarov技术治疗Pilon骨折术后感染性骨坏死[J]. 实用骨科杂志, 2021, 27(5): 401-405.
Gao Yang 1，Wang Wei 2，Wang Gongqi 2，et al. Ilizarov Technology in Treatment of Infectious Bone Necrosis After Pilon Fractures Surgery. sygkzz, 2021, 27(5): 401-405.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2021/V27/I5/401

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