带蒂筋膜瓣包裹自体红骨髓复合体修复骨缺损的疗效  

Bone composite with autologous red bone marrow and wrapped by a pedicle fascial flap for treatment of bone defects after limb wound with low toxicity infection

作　　者：杨新明[1] 孟宪勇[1] 张瑛[1] 王耀一[1] 胡振顺[1] 阴彦林[1] 张军威[1] 张培楠[1] 赵御森[2] 王海波[2] 

机构地区：[1]河北北方学院附属第一医院骨科,河北省张家口市075000 [2]河北北方学院

出　　处：《中华创伤骨科杂志》2012年第9期741-747,共7页Chinese Journal of Orthopaedic Trauma

基　　金：河北省医学科学研究重点计划（20100481）;河北省科学技术研究与发展计划（09276102D-46）

摘　　要：目的通过与病灶清除植入自体红骨髓（ARBM）复合体进行比较，探讨病灶清除植入带蒂筋膜瓣包裹ARBM复合体治疗四肢创伤后低毒力感染性骨缺损的效果。方法将2006年1月至2011年4月收治的42例四肢创伤后低毒力感染性骨缺损患者分为A、B两组，A组20例患者病灶清除植入ARBM与含骨形态发生蛋白的骨诱导活性材料复合体，B组22例患者采用病灶清除在骨缺损邻近制备一个带蒂筋膜瓣，使其包裹复合体并充填骨缺损。两组患者一般资料比较差异均无统计学意义（P〉0．05），具有可比性。部分患者做组织学和细菌学检查，并比较两组患者术后3、6、12、18个月的血常规、血沉、超敏C反应蛋白、x线片量化评分及骨折愈合时间。结果所有患者术后平均随访14．3个月。术后A组5例、B组1例患者原伤口有窦道形成且有炎性分泌物，术后10个月再次行病灶清除植入带蒂筋膜瓣包裹的ARBM复合体，随访12个月效果良好。两组其他患者伤口愈合好且无炎性窦道形成。A组5例患者原病变区骨断端之间仍有纤维结缔组织相连，骨髓腔未通，有炎性细胞浸润；B组6例患者组织学显示原筋膜瓣形成类似骨膜样纤维组织，新骨中散在少量软骨，骨髓腔再通，无炎性细胞浸润，细菌学检查阴性。两组术后各时间点血常规、血沉、超敏C反应蛋白、x线量化评分及不同部位骨折愈合时间比较，B组明显优于A组，差异均有统计学意义（P〈0．05）。结论与植入ARBM复合体治疗低毒力感染性骨缺损比较，病灶清除植入带蒂筋膜瓣包裹ARBM复合体，抗感染的能力更强，在缩短骨缺损修复时间方面有显著优势。Objective To study the effect of implantation of bone composite with autologous red bone marrow （ARBM） and wrapped by a pedicle fascial flap following debridement of infection focus in the treatment of bone defect after limb wound with low toxicity infection in comparison with implantation of bone composite only with ARBM. Methods From January of 2006 to April of 2011, 42 patients with limb wound with low toxicity infection were randomized into Group A and Group B. In Group A （20 cases）, ARBM bone composite containing bone morphogenetic protein （BMP） and osteoinductive absorbing material （OAM） was implanted after debridement of infection focus; in Group B （22 cases）, a pedicle faseial flap was prepared close to the bone defect to wrap the same bone composite as used in Group A before it was implanted. The 2 groups were comparable in general clinical data （ P 〉 0.05） . Histological and bacteriological tests were conducted for necessary cases. Blood routine, blood sedimentation, C-reactive protein, X-ray evaluation and fracture healing time were compared between the 2 groups at the 3rd, 6th, 12th and 18th months postoperation. Results The 42 patients were followed up for 14.3 months on average. Inflammatory sinus tract and inflammatory secretion, occurring in 5 cases in Group A and one case in Group B, were treated secondarily 10 months postoperation by infection focus debridement before implantation of ARBM bone composite wrapped by a pedicle fascial flap. The follow-up at 12 months showed fine outcomes. The wounds healed well and there was no sinus tract in the other cases in the 2 groups. The histological examinations showed 5 cases in Group A had still fibrous connective tissue between the previous broken bone ends, an obstructed medullary canal and inflammatory cell infiltration while 6 cases in Group B had periosteum-like tissue forming from the previous pedicle faseial flap, a little cartilage scattered in the new bone, an unobstructed medullary cavity, no inflammatory cell infiltra

关 键 词：骨 创伤和损伤 骨髓 外科手术 

分 类 号：R687.3[医药卫生—骨科学]