游离旋髂浅动脉髂骨膜骨瓣的设计与应用  

The Design and Clinical Application of a free Periosteal Iliac Graft based on the Superficial Circumflex Vessel

作　　者：潘朝晖[1] 蒋萍萍[1] 薛山[1] 刘学胜[1] 李洪飞[1] 赵玉祥[1] 

机构地区：[1]解放军第八十九医院全军创伤骨科研究所,山东潍坊261021

出　　处：《中国伤残医学》2012年第9期126-128,共3页Chinese Journal of Trauma and Disability Medicine

基　　金：军队"十二五"面上课题资助项目;编号:CWS11J245

摘　　要：目的:探讨游离旋髂浅动脉髂骨膜骨瓣修复难治性骨不连、骨缺损的应用特点。方法:从2009年2月～2011年2月设计、应用旋髂浅动脉髂骨膜骨瓣治疗难治性骨不连、骨缺损20例,其中舟状骨骨折骨不连并近端坏死8例,管状骨骨不连并骨缺损7例,手、足肿瘤术后骨缺损5例。以定期X片检查及临床症状分析判断骨愈合情况。结果:本组切取髂骨膜骨瓣平均时间52.4min,平均血管蒂长4.2cm,动脉平均管径0.8mm,伴行静脉平均管径0.7mm。骨瓣大小7cm×2cm×0.8cm～1cm×0.8cm×0.5cm。切口1期愈合。所有患者获得6个月以上随访,平均骨愈合时间:舟状骨骨不连3.9个月,管状骨骨不连并缺损3.4个月,手足肿瘤性骨缺损2.2个月。供区无疼痛,无瘢痕增生及瘢痕疙瘩。2例髋部外形轮廓略凹陷。1例大腿外侧皮肤感觉减退,4个月后自行恢复。结论:以旋髂浅动脉为蒂可成功切取游离骨膜骨瓣治疗难治性骨不连、骨缺损,供区损伤小。Objective： To investigate the clinical application of a free periosteal iliac graft based on the superficial circumflex vessel. Methods： From February 2009 to February 2011, the free periosteal iliac graft was designed and applied to twenty patients. A total of eight patients had established scaphoid nonunion with the proximal part necrosis, seven had recalcitrant tubular bone nonunion and defect, and five for the reconstruction of bone defect caused by tumor resection in hand or foot. Only the clinical analysis and radiographic outcome was focused on. Results： The average time spending on dissecting flap was 52.4 rain, and the average length of the pedicle was 4.2 cm. The size of osseous flaps ranged from 7 cm ~ 2 cm ~ 0.8 cm to 1 crn ~ 0.8 cm x 0.5 cm. Incisions of both donor and receipt site healed primarily. All patients were followed-up more than six months, the average time to union was 3.9 months in patients with scalphoid nonunion, 3.4 months in patients with tubular bone nonunion and defect, and 2.2 months in patients with tumor resection in hand or foot. No patient complained of pain at the donor site. There was no hypertrophic scars or genuine keloids. Changes in the lateral contour of hip were slightly visible in two patients. Transient numbness in lateral thigh in one case due to injury to lateral femoral cutaneous nerve, and recovered within 4 months. Conclusion： The results of this investigation support the use of a free periostreal iliac graft based on the superficial circumflex vessel for the treatment of nonunion and bone defect with a minimal donor site morbidity.

关 键 词：血管化骨移植 骨折 骨不连 骨膜 骨缺损 舟状骨骨不连 

分 类 号：R735.1[医药卫生—肿瘤]