联合取骨诱导膜、线网与钛网包裹植骨治疗大段骨缺损  

Encapsulation of bone grafts using osteoinduction membrane, wire mesh or titanium mesh for repair of large-segmental bone defects

作　　者：韩晓飞 刘宇 徐可林 周子红[2] 顾三军 殷渠东 Han Xiao-fei;Liu Yu;Xu Ke-lin;Zhou Zi-hong;Gu San-jun;Yin Qu-dong(Department of Orthopaedics,Wuxi No.9 People’s Hospital,Wuxi 214062,Jiangsu Province,China;Department of Orthopaedics,Wuxi People’s Hospital,Wuxi 214000,Jiangsu Province,China)

机构地区：[1]无锡市第九人民医院骨科,江苏省无锡市214062 [2]无锡市人民医院骨科,江苏省无锡市214000

出　　处：《中国组织工程研究》2018年第30期4782-4787,共6页Chinese Journal of Tissue Engineering Research

基　　金：无锡市卫计委课题(T201641)~~

摘　　要：背景:包裹植骨可治疗大段骨缺损,但包裹植骨治疗大段骨缺损需要大量自体松质骨,如何获取大量自体松质骨仍是临床研究课题。目的:探讨联合取骨行包裹植骨治疗大段骨缺损的效果。方法:回顾分析21例四肢长骨大段骨缺损患者的临床资料,其中男15例,女6例,年龄15-69岁,均进行自体联合取骨行包裹植骨治疗,从髂后、胫骨近端或髂前等部位联合切取丰富松质骨,其中采用诱导膜包裹植骨材料9例、钛网包裹植骨材料7例、线网包裹植骨材料5例。随访观察患者骨愈合、患肢功能恢复、邻近关节活动度和并发症情况。结果与结论:(1)随访12-51个月,诱导膜包裹者临床愈合时间平均6个月,钛网包裹者平均6.29个月,线网包裹者平均6.6个月;(2)末次随访,骨缺损愈合分级评估,优20例、良1例;患肢功能恢复评估,优7例、良9例、可4例、差1例,优良率为76%;邻近关节活动度评估,优8例、良9例,可3例、差1例,优良率为81%;(3)植骨区并发症4例,取骨区并发症3例,无内固定器断裂和再骨折;(4)结果表明,联合取骨可满足大段骨缺损需要大量自体松质骨的需求,行包裹植骨治疗的骨愈合率高、愈合较快,并发症较少。BACKGROUND:Encapsulated bone graft is considered suitable for the treatment of large-segmental bone defects,but a large volume of autogenous cancellous bone tissues is needed and how to harvest cancellous bone is still an issue of clinical research.OBJECTIVE:To investigate the effect of encapsulated bone graft by united procurement for repair of large-segmental bone defects.METHODS:Clinical data from 21 cases of large-segmental bone defects treated with encapsulated autologous bone grafts were retrospectively analyzed.There were 15 males and 6 females,aged 15-69 years.Rich cancellous bone was harvested from the posterior iliac,proximal tibia or anterior iliac.Encapsulation of bone grafts using osteoinduction membrane,titanium mesh and wire mesh was conducted in 9,7,and 5 cases,respectively.Bone healing,functional recovery of affected limbs,range of motion of adjacent joints and complications were observed during follow-up period.RESULTS AND CONCLUSION:During the follow-up of 12-51 months,the average time for bone healing was 6 months for encapsulation using osteoinduction membrane,6.29 months for encapsulation using titanium mesh,and 6.6 months for encapsulation using wire mesh.At the last follow-up,bone healing was excellent in 20 cases and good in 1 case;the functional recovery of the affected limb was excellent in 7 cases,good in 9 cases,fair in 4 cases and poor in 1 case,with the excellent and good rate of 76%.The range of motion of adjacent joints was excellent in 8 cases,good in 9 cases,fair in 3 cases and poor in 1 case,with the excellent and good rate of 81%.Complications in grafting sites were noted in 4 cases,and complications in harvesting sites were noted in 3 cases.These findings indicate that united harvesting of bone tissues can meet the requirement for a large volume of autogenous cancellous bone in the repair of large-segmental bone defects.Encapsulated bone graft has high healing rate,fast healing as well as few complications.

关 键 词：骨缺损 联合取骨 游离植骨 松质骨 包裹植骨 生物材料 骨移植 组织工程 

分 类 号：R318[医药卫生—生物医学工程]