半开放植骨治疗下肢感染性骨缺损伴软组织缺损  

Semi-open cancellous bone grafting for infected bone defect combined with soft tissue defect of lower limb

作　　者：吴天昊[1] 张彦龙[1] 王泳[1] 张晓[1] 田书委 吴希瑞[1] 彭阿钦[1] Wu Tianhao;Zhang Yanlong;Wang Yong;Zhang Xiao;Tian Shuwei;Wu Xirui;Peng Aqin(Key Laboratory of Orthopedical Biomechanics of Hebei Province,Orthopedic Institute of Hebei Province,Department of Orthopedics,Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院骨科,河北省骨科研究所,河北省骨科生物力学重点实验室,石家庄050051

出　　处：《中华创伤杂志》2019年第2期101-108,共8页Chinese Journal of Trauma

基　　金：河北省科技计划项目(14277745D);河北省卫生厅科研基金(20130223).

摘　　要：目的探讨应用半开放植骨治疗下肢感染性骨缺损伴软组织缺损的临床疗效。方法采用回顾性病例对照研究分析2010年3月—2017年8月河北医科大学第三医院收治的26例下肢感染性骨缺损伴软组织缺损患者的临床资料,其中男16例,女10例;年龄16~65岁[(39.6±12.8)岁]。植骨前骨缺损为1.4~6.0 cm[(3.3±1.2)cm],植骨后植骨颗粒表层软组织缺损为2.3 cm×1.1 cm^8.5 cm×5.0 cm。均先行创面清创,若骨缺损为>6 cm的节段性缺损,则先行骨搬移缩小骨缺损,待骨缺损临近对接时,再在对接点行开放植骨修复骨缺损;若骨缺损位于跟骨或胫骨干骺端,则在清创后行Ⅰ期或Ⅱ期开放植骨。植骨后用含抗生素骨水泥片覆盖植骨创面14例(半开放植骨组),植骨后用负压封闭引流(VSD)装置覆盖植骨创面12例(VSD组)。比较两组患者植骨后肉芽组织覆盖植骨颗粒时间、创面愈合时间、骨缺损愈合时间、植骨后覆盖创面材料费用及并发症(创面感染、植骨颗粒坏死)发生情况。依据Paley评分标准评价患肢功能。结果患者均获随访12~40个月[(19.3±7.2)个月]。半开放植骨组和VSD组植骨创面肉芽组织覆盖时间分别为22.2 d(15.0~44.0 d)和20.2 d(15.0~24.0 d)(P>0.05),创面愈合时间分别为3.1个月(1.5~5.5个月)和3.1个月(1.5~6.5个月)(P>0.05);骨缺损愈合时间分别为(5.5±2.2)个月和(5.9±2.4)个月(P>0.05);植骨后覆盖创面材料费用分别为(2 056.1±23.4)元和(5 555.3±1 105.5)元(P<0.05)。两组创面均无感染。半开放植骨组和VSD组术后植骨颗粒表层坏死分别为2例和1例(P>0.05)。按Paley功能评分标准:半开放植骨组优12例,良2例;VSD组优11例,良1例(P>0.05)。结论对于下肢感染性骨缺损伴软组织缺损,半开放植骨术可简化开放植骨后创面的护理,防止创面感染,促进创面和骨折愈合,与VSD的治疗效果相似,但治疗费用明显降低。Objective To investigate the clinical efficacy of semi-open cancellous bone grafting for infected bone defect combined with soft tissue defect of lower limb.Methods A retrospective case control study was conducted to analyze the clinical data of 26 patients with infected bone defect combined with soft tissue defect of lower limb admitted to the Third Hospital of Hebei Medical University from March 2010 to August 2017.There were 16 males and 10 females,aged 16-65 years[(39.6±12.8)years].The bone defect area before bone grafting was 1.4-6.0 cm[(3.3±1.2)cm].The surface soft tissue defect of bone graft granules was 2.3 cm×1.1 cm-8.5 cm×5.0 cm after bone grafting.If the defect was segmental defect of more than 6 cm,the defect was firstly reduced by bone transport.When the defect was near the docking point,the bone defect was repaired by open bone grafting.If the defect was located at the metaphyseal end of the calcaneus or tibia,stage I or stage II open bone grafting was performed after debridement.After bone grafting,antibiotic-containing cement sheets were used to cover the wound in 14 patients(semi-open group),and vacuum sealing drainage(VSD)devices were used to cover the wound in 12 patients(VSD group).The time of granulation tissue covering bone graft granules,wound healing time,bone defect healing time,material cost and complications(wound infection and necrosis of bone graft granules)were compared between the two groups.The limb function was evaluated according to Paley score.Results All patients were followed up for 12-40 months[(19.3±7.2)months].In the semi-open group and VSD group,the time of granulation tissue coverage was 22.2 days(15.0-44.0)days and 20.2 days(15.0-44.0)days(P>0.05);wound healing time was 3.1 months(1.5-5.5)months and 3.1 months(1.5-6.5)months(P>0.05);bone defect healing time was(5.5±2.2)months and(5.9±2.4)months(P>0.05);the cost of covering wound materials was(2 056.1±23.4)yuan and(5 555.3±1 105.5)yuan respectively(P<0.05).No wound infection occurred in either group.Two patients

关 键 词：下肢 骨髓炎 骨折 不愈合 骨移植 软组织损伤 

分 类 号：R687.3[医药卫生—骨科学]