显微骨移植个性化方案在27例骨缺损治疗中的应用  

ividualized design and clinical application in 27 cases of bone transplantation

作　　者：张敬良[1] 雷彦文[1] 何明飞[1] 万华[1] 黄忠明[1] 郭桥鸿 吴祥[1] 李亮[1] 刘超[1] 高增阳 谢振荣[1] 

机构地区：[1]广州中医药大学顺德和平外科医院,广东省和迈骨科疾病研究所显微外科,广东省顺德市528308

出　　处：《中华显微外科杂志》2017年第1期41-45,共5页Chinese Journal of Microsurgery

摘　　要：目的通过对各种不同骨缺损病例的分析，针对性的梳理、分类并制定显微骨移植修复骨缺损的个性化设计及治疗原则，以追求更为理想的治疗效果。 方法在2009年1月至2014年12月间的27例各种骨缺损病例，每例均进行详细的病情评估，根据年龄、缺损部位、缺损范围、缺损形态等不同因素和特点，制定详细、合理、个性化的显微外科骨移植技术方案并分为单段长腓骨、对折双段腓骨，双段腓骨的正、倒等腰三角支撑、不规则形态骨缺损的髂骨雕刻，骨、皮肤、肌腱复合组织瓣联合移植等类型进行骨缺损的游离骨移植修复。结果本组27例随访6个月-5年，13例髂骨、12例腓骨、胫骨及足舟骨骨移植各1例均按照生理性骨折愈合时间一期骨愈合，无延迟及不愈合情况发生。其中1例小儿股骨干2年后周径接近正常股骨。正、倒等腰三角支撑骨移植2例，2年后，三角中央空缺圆洞近乎消失。1例＂ E＂型不规则形态骨缺损雕刻髂骨移植的Pilon骨折畸形愈合病例术后无内翻及外翻畸形，行走自如。骨、皮肤、肌腱联合移植的外踝重建病例踝关节无疼痛，功能无异常。7例手部骨缺损功能评定优良率80%。1例腓骨皮瓣因皮瓣穿支血运供血略差，远端部分真皮层溃烂，后经换药愈合。结论在突破游离组织移植成活瓶颈及丰富的临床经验前提下，本着追求最终最佳效果的宗旨，充分利用显微骨移植的及时性、灵活性、自由性、确定性、血运好、一次性治愈疗程短并骨与皮肤、肌腱等同时修复的优点，在大原则下个性化的针对每一例不同情况的骨缺损患者进行显微外科游离骨移植治疗，明显提高治疗效果和患者的满意度，值得重视和推广。ObjectiveTo analyze the clinical characteristics of bone defects in various cases for the individualized design and treatment of bone transplantation.MethodsFrom January, 2009 to December, 2014, 27 cases of bone defect cases were treated. Each case was detailed condition assessment, according to age, defect shape, defect region on the body and so on a variety of factors, formulate detailed and reasonable treatment scheme, using single fibula, folded fibula, fibula tripodism and iliac bone morphology rules, combined with bone and soft tissue flap, in order to achieve the final best effect.ResultsA group of 27 cases of bone transplantation, including patients with chronic osteomyelitis, in accordance with the normal fracture healing time to healing in the 13 iliac bone, 12 fibulae, 1 tibias bone and 1 navicular bone replantation, followed up 6 months to 5 years without delay and nonunion occurred. Two years later, the 1 child case femoral shaft diameter close to normal femur. Two cases triangular supporting bone graft after 2 years by thick, triangular central formate to a circular hole. The ＂E＂ type deformity of the Pilon fracture was not only disappear in this case after the operation, but also walking freely. One case of lateral ankle reconstruction was without pain, no abnormal function. Seven cases with hand bone transplantation had no delayed union and hand function evaluation： 80%. One case with fibular flap blood supply problem, part of dermal ulceration, healed after change dressings.ConclusionUnder the premise in master microsurgical technique and rich clinical experience, based on the purpose of the final best effect, each case different situations of patients with bone defects by a personalized microsurgical free bone transplantation in the treatment can greatly shorten the course of treatment, improve treatment effect and patient satisfaction. It is worth attention and promotion.

关 键 词：骨缺损 骨移植 个性化方案 显微外科技术 

分 类 号：R687.3[医药卫生—骨科学]