膜诱导技术治疗成人长骨大段骨缺损疗效分析  

Effect of induced membrane technique for the treatment of adult long bone segmental defects

作　　者：胡汉[1] 田竞[2] 刘欣伟[2] 项良碧[2] 周大鹏[2] HU Han TIAN Jing LIU Xin-wei XIANG Liang-bi ZHOU Da-peng(Postgraduate Training Base, The General Hospital of Shenyang Military Command, Shenyang 110016, China)

机构地区：[1]辽宁医学院沈阳军区总医院研究生培养基地,辽宁沈阳110016 [2]沈阳军区总医院骨科全军重症创伤治疗中心,辽宁沈阳110016

出　　处：《临床军医杂志》2016年第10期1029-1032,共4页Clinical Journal of Medical Officers

基　　金：全军重大课题(AWS14C003)

摘　　要：目的探讨膜诱导技术治疗成人长骨大段骨缺损的临床疗效。方法自2012年1月至2015年1月,沈阳军区总医院利用膜诱导技术治疗成人长骨大段骨缺损患者31例。其中,17例初始损伤为开放粉碎性骨折合并感染,13例为慢性骨髓炎,1例为大段骨囊肿。Ⅰ期彻底清创后骨缺损长度为6.7~12.1 cm,平均（7.5±1.2）cm,在骨缺损处填塞抗生素骨水泥诱导生成生物膜,并修复缺损的皮瓣。Ⅱ期在膜内植自体髂骨,修复骨缺损,观察膜诱导技术治疗成人长骨大段骨缺损临床疗效。术后末次随访采用中文版SF-36量表评定手术疗效。结果所有患者均获得随访,随访时间11~34个月,平均（28.5±3.0）个月。其中,28例患者在5~7个月获得Ⅰ期骨愈合,平均（5.3±1.7）个月;2例Ⅱ期术后发生感染,再次行膜诱导技术治疗,达到临床骨愈合;1例出现踝关节僵直;其余未出现术后并发症。末次随访SF-36量表各项评分均较术前改善（P〈0.05）。结论膜诱导技术治疗胫骨大段骨缺损可取得良好疗效。Objective To explore the clinical efficacy of induced membrane technique for reconstruction of adult long bone segmental defects. Methods A retrospective study was performed on 31 adult patients with adult long bone segmental defects that were treated under induced membrane technique in the General Hospital of Shenyang Military Command from January 2012 to January 2015. Among the patients,17 cases of initial damage for open comminuted fracture merge infection,13 cases of chronic osteomyelitis,1 case of long bone cyst. After Stage I of debridement,mean bone defect length was（ 7. 5 ± 1. 2） cm（ ranged from 6. 7 to 12. 1 cm）,the bone defect was filled with antibiotic bone cement and the skin flap was repaired. In Stage II,intramembranous bone grafting was used to perform defect reconstruction. The curative effect of membrane technique in adult long bone defect was observed. At the end of the postoperative follow-up time using Chinese SF-36 scale to evaluate the surgical curative effect. Results The average duration of follow-up was（ 28. 5 ± 3. 0） months（ ranged from 11 to 34 months）. There were 28 patients obtained one-stage bone healing at a mean time of（ 5. 3 ± 1. 7） months（ ranged from 5 to 7 months）. Two patients were with postoperative infection at the second stage and treated by inducted membrane technique again which obtained clinical bone healing. One patient was ankle stiffness. There were no other postoperative complication. The last follow-up SF-36 scale scores were improved comparing with those before operation（ P〈0. 05）. Conclusion The induced membrane technology in reconstructions of tibial long bone defect can achieve good curative effect.

关 键 词：成人 膜诱导技术 大段骨缺损 疗效 

分 类 号：R687.3[医药卫生—骨科学]