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奇妙的骨搬移：illizarov应对骨缺损的又一神作！骨搬移技术（bone transport）是 20 世纪 70 年代伊利扎洛夫医师又一独创的治疗骨缺损的方法，80 年代后逐渐应用于临床。
具体方法是通过外固定器对骨缺损的肢体提供支持（固定），然后在骨缺损骨干的上或下端人为地将正常骨截断，将外固定架上可移动的钢针固定在截断的正常的活性骨块上。
按照既定的方向、合适的速度与频率，人为地每天移动（约1 mm）截断的骨块，使骨块逐渐与对应的骨缺损的断端靠拢，进而修复骨缺损。
伊利扎洛夫骨搬移技术（模拟图）A. 伊利扎洛夫骨搬移法；B. 在骨缺损上端正常骨干部位做截骨；C. 待机 2 周后，每天 1 mm 距离移动截断的活骨块，最后将骨缺损修复。
这个过程与单纯牵拉（张应力）的骨延长不同，它是牵拉应力（张应力）和压缩应力（压应力）同时作用产生的生物学效应。
即：牵拉使部分骨组织延长再生；压缩使骨缺损内的软组织，包括炎性的瘢痕组织等在内的一部分组织凋亡或发生转化，再根据局部组织的功能需求进行再生修复。
病例示图：伊利扎洛夫骨搬移技术骨搬移骨形成方式骨搬移技术治疗骨缺损，其生物学原理是以每天1 mm 的速度不断移动活性骨块的位置，通过骨再生和不需要的软组织消失或转化后发生组织再生的方式完成的。
骨搬移的骨再生过程主要包括两部分：•一部分是截骨延长部位的「牵拉性骨再生」。
•一部分是移动具有活性的骨块被逐渐压缩将骨缺损部位修复的「引导性骨再生」。
1、牵拉性骨再生骨搬移过程中骨延长部分的生物学原理被称为伊利扎洛夫「张力牵拉法则」（Low of tension-stress），也被誉为 20 世纪骨科领域最重大的发现之一。
①组织逐渐被牵拉而达到一种紧张状态，这种张力紧张状态可促进组织的再生、发育，它主要表现为血管内皮细胞向多形态间充质细胞移行，最后演变为成骨细胞。
这种确实的慢性牵拉作用，可促进组织代谢及细胞合成，增殖加快（细胞内线粒体增大，其中含有核糖体的小胞体大量增殖，细胞核内的核小体量增加）。
Ilizarov骨搬移术治疗胫骨感染性骨缺损董帅;蔡喜雨【期刊名称】《中国继续医学教育》【年(卷),期】2016(008)024【摘要】Objective To explore the clinical effect of Ilizarov technique in infected tibia defect.Methods 17 cases of tibial fracture surgery infection segmental defects were chosen from May 2012 to May 2015 and used bone transport technique in the treatment. 11 males and 6 females, mean age was (32±1.4) years. After phaseⅠ debridement in 17 patients with bone defect lengths were>5 cm, phaseⅡ was given bonetransport.Results17 patients were followed up for 12 to 26 months, the mean time was (15±0.7) months. 17 patients osteotomy extend the length was 5 ~ 13cm. 5 cases Ⅰhealed stump, stump clean up bone grafting in 12 cases healed.Conclusion Ilizarov technique is effective in the treatment of infected tibia bone defect.%目的：探讨Ilizarov骨搬移技术治疗胫骨骨折术后感染性骨缺损临床疗效。
适宜于肱骨近端复杂性骨折的固定。
T形钢板较宽的横臂和纵臂近端可压住骨折片和植骨块,其纵臂与骨折远段牢固连接,使钢板横臂上几枚拧入肱骨头内的松质骨螺钉和植入的骨块得到坚实的支撑,可满足术后早期功能锻炼的要求。
三叶草形钢板臂薄,可随意塑形,三叶塑形可分别固定挤压肱骨头内、外、前、上四面而固定骨折,且有较强的抗旋转力与抗剪切力,固定后可早期功能锻炼。
而克氏针、螺丝钉、钢丝等内固定物虽具有创伤小、对肩袖和肱骨头血运影响小的优点,但缺乏跨越肱骨头颈骨折断端的坚强支臂,术后需辅以长时间的外固定,易造成肩关节粘连和僵硬。
陆晴友等[5]也认为克氏针、螺丝钉、张力带钢丝虽然操作简便、再损伤小,但对于严重粉碎性骨折及骨质疏松患者不宜选用。
我们认为保证手术成功的经验是:①术中无需力求解剖复位而剥离更多的软组织,以免加重损伤肱骨头的血循环,关键是将肩袖(包括大小结节骨块)恢复原位并妥善固定;②肱骨近端移位严重的N eer 型和 型骨折,因肱骨解剖颈处髓腔内松质骨较多,骨折后多造成松质骨压缩,骨质缺损,为防止肱骨头塌陷,恢复关节面平整,则必须植骨;③钢板应放置在肱二头肌腱外侧,近段不超过肱骨大结节上界,以防肩外展时肩峰下撞击,若放置偏内侧,则影响内旋功能。
肱骨近端严重粉碎性骨折并脱位最主要的并发症是肱骨头缺血坏死,主要临床表现为肩关节外展受限、疼痛。
肱骨头缺血性坏死主要有完全性坏死和部分坏死两种形式,完全性坏死是肱骨头整体性萎缩,部分坏死是肱骨头暂时性骨囊腔及骨硬化形式。
肱骨头血供主要来自旋肱前动脉的前外侧升支,该动脉任何形式的创伤均可导致肱骨头缺血坏死。
但是肩关节是一相对非负重关节,肱骨头的缺血性坏死并不一定造成肩关节较差的结果。
本组术后4例(4 19)发生肱骨头部分坏死,但肩关节功能在良与可之间。
发生肱骨头坏死的原因主要是碎裂游离的肱骨头血供彻底破坏、旋肱前动脉的前外侧分支损伤及切开复位时对肩周组织过度剥离。
因此要防止肱骨头坏死发生,术中尽可能少剥离关节囊是非常重要的。
Ilizarov骨搬移技术在胫骨缺损中的应用研究摘要】目的：探讨Ilizarov骨搬移技术在胫骨缺损中的应用。
方法：以我院2015年3年—2018年6月45例大段胫骨骨缺损患者为研究对象，随机将23例纳入观察组，给予Ilizarov骨搬移技术对患者进行治疗，剩余22例纳入对照组，给予同侧带蒂腓骨转移术进行治疗。
对比两组骨性愈合时间，采用AKS评分与Baird评分分别对比两组膝关节与踝关节功能，采用Fernandez-Esteve评分对比两组骨架痂分，对比两组术后并发症状况。
结果：两组骨性愈合时间、术后并发症无明显差异（P＞0.05）；观察组AKS评分与Baird评分与对照组相比明显较高（P＜0.05）；观察组Fernandez-Esteve评分与对照组相比明显较高（P＜0.05）。
结论：Ilizarov骨搬移技术能够更好的促进患者骨性愈合，有利于患者膝关节及踝关节的恢复，且患者并无明显并发症，值得临床推广应用。
【关键词】 Ilizarov骨搬移技术胫骨缺损应用研究【中图分类号】R687 【文献标识码】A 【文章编号】2095-1752（2018）36-0090-02胫骨骨缺损多数是由高能量的暴力造成，也有部分患者是由于开放性骨折后滋养血管受到损伤进而造成骨髓炎而引起的[1-3]。
Ilizarov骨搬移技术按照“张力-应力原则”，采用体外穿针技术将钢针固定于患者的骨骼上，通过牵拉长骨生成的新骨组织填补骨缺损，在延长去与加压区都可以达到骨痂的生长，直到愈合，是临床治疗骨缺损的一种新技术[4，5]。
我科对我院收集的23例胫骨骨缺损患者进行了Ilizarov骨搬移技术治疗，现报道如下。
1.资料与方法1.1 临床资料以我院2015年3年—2018年6月45例大段胫骨骨缺损患者为研究对象，随机将23例纳入观察组，给予Ilizarov骨搬移技术对患者进行治疗，剩余22例纳入对照组，给予同侧带蒂腓骨转移术进行治疗。
择期Ilizarov骨搬移技术治疗胫骨感染性骨缺损曹建明;周亚净;朱巧辉;王双;王福川【摘要】Objective The present study was performed to explore the clinical outcome of bone transport with the llizarov technique using an external fixator for treating infected bone defects of the tibia.Methods A total of 1 7 cases underwent elective llizarov surgery were enrolled in our hospital between Nov.2011 and Jan.2011.Bone transport was performed with llizarov circular external fixator.There were 1 3 males and 4 females,with average age of 3 6 years (range:20~59 years).The causes for bone defects included traffic accidents (9 cases),falling from a height (5 cases), bruise (3 cases).All patients were diagnosed with open fracture wounds:one with Gustilo Ⅱ open injury,five with Gustilo Ⅲ A open inj ury,seven wi th Gustilo Ⅲ A open inj ury and four with Gustilo Ⅲ C open inj ury.Five cases were found with bone defects on the left side,while twelve cases were found on the right sideBone defects in the upper seg-ments of the tibia were observed in 7 patients,in the middle segments of the tibia were observed in 6 patients and in the lower segments of tibia were in 4 cases.The length of defect of the tibia was 6~10 cm before bone transport.The area of the defective soft tissue after wound debridement was 3 cm×4 cm~7 cm×9 cm.The first-stage operation was con-ducted to clean the wound.First the infected bone segments were removedThen the bone cement beads were implanted or the wound was covered by VSD and flap to prevent wound infection.During elective llizarov surgery,bone transport technology usingan external fixator was performed after transporting or forcing bone segments to make defective bone repair and reconstruction.Variable parameters including the length of bone detect and the duration of carrying the exter-nal fixator were recorded.Then function of inj ured limb was evaluated by scoring.Results All the patients were fol-lowed up for10~22 months with an average of 13.5 months.In 12 cases of patients with postoperative flaps survived more than 5 cases of free skin graft or wound.Tibial bone segment shifting or extension of the 6~10 cm,with an aver-age of 7 cm;external fixator carry time 7~1 6 months,the defect of the tibia were obtained reconstruction,with an aver-age of 1 1months.According to Paley standard to evaluate bone lengthening bone removal and functional results,1 3 ca-ses were excellent,good in 3 cases,1 cases,the excellent rate was 94.1%.Conclusion Given the advantages of short treatment duration and less complication,bone transport with the llizarov method and assisted with an external fixator was recommended for treating patients with infected bone defects of the tibiaMeanwhile,this technique also had an ex-cellent outcome for limb reconstruction and deformity correction.Our results provided a reference for the clinical appli-cation of this technique.%目的：探讨和总结择期 Ilizarov外固定架辅助下骨搬移技术治疗胫骨感染性骨缺损的治疗方法及临床效果。
Ilizarov骨搬运技术治疗胫骨骨缺损患者的围手术期护理措施探微发布时间：2022-05-31T02:11:36.729Z 来源：《世界复合医学》2022年4期作者：盛淑清闫烁孙艳丽祖彩霞[导读] 目的分析Ilizarov骨搬运技术治疗胫骨骨缺损患者的围手术期护理措施。
盛淑清闫烁孙艳丽祖彩霞哈尔滨市中医医院 150076【摘要】目的分析Ilizarov骨搬运技术治疗胫骨骨缺损患者的围手术期护理措施。
方法选取本院2020年3月-11月期间收治的74例行Ilizarov骨搬运技术治疗的胫骨骨缺损患者进行研究，并采取随机双盲法将其分为对照组和观察组，各37例。
给予对照组常规护理，给予观察组常规护理+围手术期护理，并对两组的护理效果进行对比。
结果观察组治疗有效率、并发症发生率优于对照组（P＜0.05）。
结论给予使用Ilizarov骨搬运技术治疗的胫骨骨缺损患者围手术期护理，能够降低并发症发生的几率，疗效显著，值得推广。
【关键词】Ilizarov骨搬运技术；胫骨骨缺损；围手术期护理；治疗有效率；并发症发生率[Abstract] Objective To analyze the perioperative nursing measures of Ilizarov bone handling technology in the treatment of tibial bone defect. Methods 74 patients with tibial bone defects treated by Ilizarov bone transport technology in our hospital from March to November 2020 were selected for study, and they were randomly divided into control group and observation group, with 37 cases in each group. Routine nursing was given to the control group and routine nursing + perioperative nursing to the observation group, and the nursing effects of the two groups were compared. Results the effective rate and complication rate of the observation group were better than those of the control group (P < 0.05). Conclusion perioperative nursing care for patients with tibial bone defect treated with Ilizarov bone transport technology can reduce the incidence of complications. The curative effect is significant and worthy of promotion.[Key words] Ilizarov bone transport technology; Tibial bone defect; Perioperative nursing; Treatment efficiency; Incidence of complications 骨缺损是指骨结构的完整性受到破坏，我国现阶段四肢高能量损伤患者数量逐渐增多，特别是开放性小腿粉碎性骨折，需要进行多次保肢手术，极易出现胫骨大段骨缺损合并小腿软组织缺损，这也是骨科医生比较难以解决的问题【1】。
