松质骨包裹植骨技术治疗长骨节段性骨缺损  

Cancellous bone wrapping grafting for segmental defects of long bone

作　　者：殷渠东 顾三军 芮永军 瞿玉兴 吴永伟 韦旭明 孙振中 

机构地区：[1]苏州大学附属无锡市第九人民医院骨科,214062 [2]江苏省常州市中医院骨伤科,213000

出　　处：《中华创伤骨科杂志》2017年第9期775-781,共7页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨松质骨包裹植骨技术治疗长骨节段性骨缺损的原理和疗效。方法回顾性分析2008年1月至2015年12月应用多种方法包裹丰富自体松质骨植骨治疗长骨节段性骨缺损50例，男31例，女19例；年龄13～69岁，平均34．6岁；其中钛网包裹植骨8例，线网包裹植骨10例，线捆绑皮质骨块包裹植骨13例，诱导膜包裹植骨19例；骨缺损部位：胫骨22例，桡骨10例，肱骨8例，尺骨7例，股骨3例；骨缺损长度3—9cm，平均5．9cm。记录骨愈合、并发症和关节功能恢复情况，骨缺损愈合和邻近关节功能恢复按Paley方法分别进行评价。结果术后切口一期愈合48例，二期愈合2例。所有患者术后获12～48个月（平均19．1个月）随访。除1例诱导膜包裹者断端连接处不愈合需要二次植骨才愈合（愈合时间为15个月）外，其余患者骨缺损均一期愈合。总体临床愈合时间为3～15个月，平均6．1个月。末次随访时患肢均恢复负重活动功能，骨缺损愈合分级：仅诱导膜组1例良，其他患者均为优；总体上邻近关节功能恢复：优18例，良22例，可7例，差3例，优良率为80．0％。结论松质骨包裹植骨技术避免或明显减少了传统方法松质骨植骨后容易松动和骨吸收现象，可以治疗长段骨缺损，应根据患者具体情况选择不同的治疗方法。Objective To investigate the principles and effects of cancellous bone wrapping grafting for treatment of segmental defects of long bone. Methods From January 2008 to December 2015, 50 patients with segmental long bone defect were treated by various wrapping grafting with rich autogenous can- cellous bone. They were 31 males and 19 fcmales, aged from 13 to 69 years （average, 34.6 years） . The cancellous bone was wrapped by titanium mesh in 8 cases, by wire mesh in 10, by line binding in 13, and by induced membrane in 19. The bone defect was located at tibia in 22 cases, at radius in 10, at humerus in 8, at ulna in 7 and at femur in 3. The length of bone defect ranged from 3 to 9 cm, averaging 5.9 cm. Bone healing, complications and functionary recovery of adjacent joint were recorded. The bone defect healing and functionary recovery of adjacent joint were evaluated according to the Paley criteria. Results The inci- sions healed by the first intention in 48 cases and by the second in 2. All were followed up for 12 to 48 months （average, 19. 1 months）. All the bone defects healed by the first intention but one treated by induced membrane wrapping which was healed 15 months later by the secondary grafting due to nonunion at ends. The total clinical healing time ranged from 3 to 16 months （average, 6. 1 months）. The last follow-ups showed that all the affected limbs resumed weight-bearing activities. The healing of bone defects was graded as excellent in all but one in the group of induced membrane wrapping. Totally, the functionary recovery of adjacent joint was excellent in 18, good in 22, fair in 7 and poor in 3 cases （an excellent and good rate of 80.0% ）. Conclusions Cancellous bone wrapping grafting can avoid or significantly reduce loosening and absorption of cancellous bone graft after tradi- tional bone grafting. Although it is effective for treatment of large segmental bone defect, its methods should vary according to the specific conditions of the patient.

关 键 词：骨 骨折 不愈合 游离植骨 包裹植骨 

分 类 号：R687.3[医药卫生—骨科学]