应用骨输送与筋膜皮瓣一期修复下肢大段(块)骨软组织缺损  

Application of bone transmission and fascia skin flap recover large defeciency of bone and soft tissue of lower limb

作　　者：张志刚[1] 王宇[1] 李海[1] 张大伟[1] 吴其常[1] 朱东[1] 闫鹏[1,2] 

机构地区：[1]解放军第208医院矫形外科中心,吉林长春130062 [2]延边大学在读硕士研究生

出　　处：《中国矫形外科杂志》2007年第8期573-576,共4页Orthopedic Journal of China

摘　　要：[目的]探讨利用Ilizarov技术骨输送与筋膜皮瓣修复下肢大段(块)骨与软组织缺损的疗效。[方法]本组12例患者,11例为小腿严重开放复合伤,1例为前臂开放复合伤,骨缺损范围4~12cm,平均8cm,皮肤缺损面积4cm×5cm^14cm×5cm,全部病例均合并急性感染。软组织缺损采用小腿外侧筋膜皮瓣修复9例,小腿内侧筋膜皮瓣修复1例,交腿皮瓣修复1例,前臂内侧皮瓣1例,12例中,骨输送幅度4~12cm,平均8cm,其中用环行外固定器4例,用本科研制的双臂骨输送外固定器8例。[结果]延长段骨和压缩骨断端均自然愈合,所有转移的筋膜皮瓣均成活,无1例形成骨不连和慢性骨髓炎。本组随访12例,随访时间2~10.8年,平均4.2年。[结论]应用Ilizarov骨输送和筋膜皮瓣转移技术治疗下肢大段(块)骨与软组织缺损是一种疗效确切方法,其优势(1)通过外固定器来保持伤肢稳定,通过骨输送的方法填补大段骨缺损;(2)同时行皮瓣转移,修复软组织缺损,为骨压缩端愈合与控制感染创造有利条件;(3)外固定器提供的撑开和压缩功能,使得延长段骨和压缩段骨断端获得骨愈合的合理的生物力学条件;(4)在骨输送过程中刺激机体的修复机制,使机体的代谢增强、血循增加、成骨因子聚集、抵抗力增强,调动了机体的主动修复机制和主动控制感染的防御机制;(5)在外固定器的保护下,患者的伤肢可在康复期间进行主动的功能锻炼,从而避免长期制动和废用因素导致的骨质疏松和关节功能障碍;(6)治疗周期短,抗生素应用少,治疗费用低,并发症少。[ Objective] To research the effect of using Ilizarov technique in bone transmission and fascia skin flap for large defeciency of bone and soft tissues of lower limb. [ Method] There were 12 patients in our group, 11 patients had severe compound trauma of the leg,one in arm. Bone defeciency range was 4 - 12 cm,average 8 cm,cotaneous defeciency was 4 ×5 cm^2 - 14 ×5 cm^2, and all of them had acute infection. Nine had been treated with leg lateral fascia skin flap, 1 had been treated with leg fascia skin flap,1 had been treated with the opposide leg skin flap,1 had been treated with the arm fascia skin flap,in 12 bone transport,elongation range was 4 - 12 cm,average 8 cm. Eight had been used double arms external fixation device,4 cases had been used circle shape external fixation device. [ Result] Totally 12 patients were followed up for 2 - 10.8 years （average ,4.2 years） elongation part and compressed part healed naturally, all of the fascia shin flap were alive. No bone ununion and chronic osteomyelitis appeared. [ Conclusion] Using Ilizarov bone transport technique and fascia skin flap is a good way for treating large defeciency of bone and soft tissue. Its advantages ： （ 1 ） The wound limb can maintain stability by external fixatian device. The methed of the bone transportation can fill big section bone deficiency;（2 ） In the same time the fascia shin flap may be transported, and repair soft tissue deficiency,provide good condition to bone＇s healing and control infection; （3）The external fixation device can provide distraction and compression functions, this function makes elongation part and compressed part obtain the reasonable biomechanics condition which would be good to bone healing; （4）The course of bone transmission can stimulate bone repair mechanisms, to enhance the wound limb metabolism, increase blood supply circularation, the grown bone factor aggregation,enhance the body＇s initiative repair mechanisms and infection controlling mechanism; （5）In the protection of the

关 键 词：外固定架 肢体延长 皮瓣 截骨 

分 类 号：R687.3[医药卫生—骨科学]