二处截骨骨搬移治疗胫骨

Bilocal Osteosynthesis for Large Segmental Defects of the Tibias and Skin二处截骨骨搬移治疗胫骨大段骨和软组织缺损,Research Institute of Traumatic Orthopaedics of Kunming General Hospital, PLA.M.D. Yong-Qing Xu成都军区昆明总医院全军创伤骨科研究所徐永清 朱跃良 林玮 范新宇何晓青 王毅,Combined large defects of bone and skin of the leg remains to be a great challenge！Traditional treatments:Microsurgical treatment or Ilizarov principles External fixation with flap transfer with bone graftsFree fibulas flapMonolocal osteosynthesis,长节段的复合骨和软组织缺损依旧是治疗难题传统的方法：显微外科技术或ILIZAROV技术外固定合并皮瓣合并植骨游离腓骨皮瓣单处截骨延长,Lets Review These techniques,Free flap transfer combined with external fixations,吻合血管的游离皮瓣与外固定架联合,CASE 1,Free thoracoumbilical flap,CASE 2,Free thoracoumbilical flap,CASE 3,CASE 4,Free thoracoumbilical flap,CASE 5,一处截骨,Monolocal osteosynthesis,CASE 1,CASE 2,After flap transfer and skin grafts.,Long segmental defects,Boy, 6 ys,CASE 3,2 years later,CASE 4,After local flap transfers,CASE 6,One-stage flap transfer and Distraction Osteosynthesis,一期皮瓣转移和延长,CASE 7,Free ALT Perforator flap,But non-union,外固定架与皮瓣联合植骨术-可以治疗小段骨缺损，对于大段长骨干缺损，则难以找到满意的替代骨；要求显微外科技术。对侧吻合血管的腓骨皮瓣移植，对于儿童和青少年，移植后的腓骨容易增粗塑形成胫骨，但对于成年人，塑形和增粗效果不佳，容易导致移植腓骨再骨折；要求显微外科技术。一期短缩加延长对于小于5cm的骨和软组织缺损较为满意，对于更长的骨缺损，由于短缩处形成皮肤皱褶，容易导致肢体血运障碍；单纯干骺端截骨延长进行骨搬移，临床最为常用，但按照目前的理论，每天的延长速度不能超过1mm，因而总体延长时间依然较长。,External fixation combined with flap transfer and bone grafts-good for small segmental defects, requires microsurgical expertise.Free fibulus flap-good for children and adolescens, not suitable for adults (re-fractures), requires microsurgical epertise.One-stage shortening and distraction osteosynthesis-only for short bone defectsOne-site (monolocal) osteosynthesis-too slow,Why do we chose bilocal osteosynthesis?,我们为何选择两处截骨？,二处截骨,Bi-local osteosynthesis,2009年5月-2011年5月，收治胫骨大段骨缺损合并软组织缺损患者6例。均为男性，年龄2051岁，平均34.5岁。均为开放性骨折（Gustilo IIIB型); 小腿胫前软组织缺损最大11 cm24 cm，最小4 cm8 cm.胫骨骨缺损818 cm。,2009-20116 casesMale, 20-51 ys, Gustilo IIIB fractures.Soft tissue defects: 11 cm24 cm4 cm8 cmTibia defects: 818 cm。,Tips of surgery1 Total removal of dead tissue2 Electric drill for holes, then chisel for osteotomy3 Local flap coverage of the exposed bone remnants,手术要点1 将污染和失活的骨、软组织彻底清除2 电钻低速横行打孔,再用骨凿。3 骨残端部分外露用局部皮瓣覆盖,CASE 1,CASE 2,一期清创骨外固定踝关节弹性牵伸清创后骨缺损约12cm,皮肤缺损约512c,术后5d,术后45天，近端