【摘要】 [目的]探讨Ilizarov外固定"手风琴技术"治疗成人股骨无菌性骨不连的临床疗效。[方法] 2012年7月～2017年1月,采用Ilizarov环形外固定缓慢牵伸-加压的"手风琴技术"治疗成人股骨无菌性骨不连11例。其中男7例,女4例,年龄24～47岁,平均(37.10±7.60)岁。患肢短缩>2.5 cm者术中结合股骨近端闭合截骨加装骨延长组件,备术后肢体延长。采用Paley骨不连评价标准进行评价。[结果] 11例患者获得随访,随访时间24～49个月,平均(27.47±6.70)个月。所有骨不连均临床骨性愈合,愈合时间6.00～24.70个月,平均(10.20±9.42)个月。采用Paley骨不连评价标准,优5例、良5例、可1例,优良率90.91%(10/11)。末次随访>7°局部畸形2例(7°、10°矢状位畸形),不影响功能,未作特殊处理。1例术后肢体短缩3.1cm。针道感染发生率72.73%(8/11),通过换药及更换固定针等控制,10°以上膝关节活动丢失3例,未发生再骨折、深部感染和血管神经损伤等并发症。[结论] Ilizarov外固定"手风琴技术"依据张力-应力法则,避免了植骨,规律牵伸-再加压治疗成人股骨无菌性骨不连疗效可靠。更多还原

【Abstract】 [Objective] To evaluate the outcomes of patients with femoral shaft nonunion treated by Ilizarov frame fixation"accordion technique". [Methods] We studied 11 consecutive patients with adult femoral nonunion: 7 male and 4 female with an average age of(37.10±7.60) years(range, 24～47 years). Closed subtrochanteric osteotomy and bone lengthening module were required in the patients with limb shortening >2.5 cm. All patients were evaluated by Paley nonunion evaluation criteria.[Results] All 11 patients were followed up. The mean postoperative follow-up was(27.47±6.70) months(range, 24～49 months).Bony union was achieved in all 11 cases after a mean of(10.20±9.42) months(range, 6.00～24.70 months). According to Paley nonunion healing score, 5 cases were excellent, 5 were good and 1 were fair, yielding an excellent to good rate of 90.91%(10/11). There were 2 local femoral shaft malformations beyond 7°(7° and 10° sagittal malformation), 1 case with limb shortening by 3.1 cm, 8 superficial pin tract infections and 3 cases with Loss of knee motion above 10°. No complications such as deep infection and vascular nerve injury occurred. [Conclusion] Ilizarov circular frame fixation "accordion technique", based on the principle of "law of tension-stress" in the way of cyclic compression and distraction without bone graft is a reliable method for the treatment of aseptic femoral shaft nonunion.更多还原