中国修复重建外科杂志

中国修复重建外科杂志

筛网状筋膜包裹松质骨植骨治疗四肢骨折后骨缺损

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目的 探讨筛网状筋膜包裹松质骨植骨治疗四肢骨折后骨缺损的效果。 方法 回顾分析 2011 年 6 月–2016 年 12 月,采用筛网状筋膜包裹松质骨植骨治疗的 21 例外伤性四肢骨折后骨缺损患者临床资料。男 13 例,女 8 例;年龄 14~64 岁,平均 40.1 岁。骨缺损部位:肱骨 3 例,桡骨 5 例,尺骨 4 例,股骨 2 例,胫骨 7 例。原发骨折 AO 分型:A 型 2 例,B 型 7 例,C 型 12 例。开放性骨折 14 例,闭合性骨折骨不连伴骨缺损 7 例。受伤至骨缺损修复时间为 5~165 d,平均 21.3 d。扩创后骨缺损长度 2.5~6.5 cm,平均 4.5 cm。 结果 手术时间 86~130 min,平均 101 min;术中出血量 185~647 mL,平均 316 mL。术后发生切口浅表感染 1 例,延期愈合 2 例;无神经血管损伤发生。21 例均获随访,随访时间 12~36 个月,平均 19 个月。骨折临床愈合时间为 2.5~7.0 个月,平均 5.4 个月,无延迟愈合和骨不连发生,愈合率为 100%。无深部感染或感染复发,无内固定物断裂和再骨折发生。末次随访时,骨缺损愈合分级均为优;患肢功能恢复分级为优 12 例、良 7 例、可 2 例,优良率 90.5%。 结论 筛网状筋膜包裹松质骨植骨治疗四肢骨折后骨缺损具有筋膜取材及手术操作简便、无不良反应、费用低、效果满意等优点。

Objective To investigate the effectiveness of meshy fascia encapsulating cancellous bone graft in repair of bone defect after limb fractures. Methods A clinical data of 21 cases of traumatic bone defect after limb fractures, who were treated with meshy fascia encapsulating cancellous bone graft between June 2011 and December 2016, was retrospectively analyzed. There were 13 males and 8 females, aged 14-64 years with an average of 40.1 years. The location of bone defect included humerus in 3 cases, radius in 5 cases, ulna in 4 cases, femur in 2 cases, and tibia in 7 cases. AO classification of primary fractures were type A in 2 cases, type B in 7 cases, and type C in 12 cases. There were 14 cases of open fracture, and 7 cases of closed fracture associated with bone defect. The time from injury to bone defect repair was 5-165 days (mean, 21.3 days). The length of bone defect was 2.5-6.5 cm with an average of 4.5 cm. Results The operation time was 86-130 minutes (mean, 101 minutes). The intraoperative blood loss was 185-647 mL (mean, 316 mL). One case of superficial infection and 2 cases of delayed healing of incision occurred after operation, and no neurovascular injury occurred. All the 21 patients were followed up 12-36 months (mean, 19 months). The clinical healing time was 2.5-7.0 months (mean, 5.4 months); no delayed healing and nonunion occurred, the bony healing rate was 100%. There was no deep infection, infection recurrence, broken of internal fixator, or refracture. At last follow-up, the grading of bony healing were all rated as excellent, and the functional recovery of the affected limb was excellent in 12 cases, good in 7 cases, and fair in 2 cases with an excellent and good rate of 90.5%. Conclusion Meshy fascia encapsulating cancellous bone graft in repair of bone defect after limb fracture is characterized by easy to harvest fascia, simplicity of operation, no adverse reaction, lower cost, and satisfactory results.

关键词: 骨缺损; 包裹植骨; 筋膜; 修复

Key words: Bone defect; encapsulated bone graft; fascia; repair

引用本文: 周子红, 赵继军, 冯德宏, 吴沼峰, 刘宇. 筛网状筋膜包裹松质骨植骨治疗四肢骨折后骨缺损. 中国修复重建外科杂志, 2018, 32(12): 1530-1533. doi: 10.7507/1002-1892.201804071 复制

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