目的

探讨应用Ilizarov 环形外固定架结合骨搬移技术急诊一期治疗严重胫骨长段开放粉碎性骨折的临床疗效。

方法

回顾性分析2019 年1 月至2022 年12 月汕头大学附属粤北人民医院创伤骨科收治的14 例Gustilo ⅢB 型严重胫骨长段开放粉碎性性骨折患者资料。 急诊手术清除患者粉碎无活力骨块，钢板或克氏针固定腓骨，一期使用Ilizarov 环形外固定架固定胫骨，胫骨干骺端截骨后搬移。 清创后胫骨存在大段骨缺损，达6.5 cm 以上。 术后定期随访，记录骨段搬移时间，骨折端愈合时间；采用Johner-Wruhs 标准评定患肢功能，Kofoed 标准评定踝关节功能。

结果

14 例患者平均随访时间14.50（11～23）个月；平均搬移时间4.39（3～8）个月；平均骨愈合时间11.50 个月。 所有患者伤口经过骨搬移后愈合良好，骨折端经过自体骨移植并加压后愈合。 2 例出现搬移骨段轴向偏移，及时调整外固定架后恢复；2 例出现成骨不全，植骨后愈合。 患肢功能优11 例，良3 例；踝关节功能优11 例，良2 例，及格1 例。

结论

一期应用Ilizarov 骨搬移技术治疗胫骨严重长段开放粉碎性骨折，可使手术次数减少，病程缩短，临床疗效良好。

Objective

To demonstrate the clinical efficacy of Ilizarov ring external fixator combined with bone moving technique in treating severe tibial open comminuted fractures.

Methods

14 cases of severe Gustilo ⅢB tibia fractures admitted to Department of Trauma Orthopedics， Yuebei People's Hospital Affiliated to Shantou University from January 2019 to December 2022.Emergency surgery to crush the nonvital bone block， plate or Kirschner wire to fix the fibula， using Ilizarov ring external holder to fix the tibia.After debridement， the tibia was over 6.5 cm.The time of bone segment removal and fracture-end healing were recorded by regular follow-up after operation.Johner-Wruhs criteria were used to assess the function of the affected limb and Kofoed criteria to assess the function of the ankle joint.

Results

The average follow-up time for 14 patients was 14.50（11-23）months.The average time of relocation is 4.39（3-8）months and the average time of bone healing is 11.50 months.All the wounds healed well after bone migration， and the fracture end healed after autologous bone grafting and compression.In 2 cases， axial deviation of the displaced bone segment， and recovery after timely adjustment of the external fixator.2 cases showed osteogenesis insufficiency and healing after bone grafting.The Johner-Wruhs criteria showed 11 excellent and 3 good.And ankle functions showed 11 excellent， 2 good and 1 pass.

Conclusion

Ilizarov bone transfer technique yields benefits for tibia fracture with severe long open comminuted fracture， few operation times， short duration and good clinical effect.