一期异位寄养大段游离骨块治疗开放性下肢骨缺损的疗效分析  

Emergency ectopic embedment of a large extruded bone mass for open lower limb bone defects

作　　者：陈森[1] 聂志刚[1] 金志辉 叶佳[1] 任义军 Chen Sen;Nie Zhigang;Jin Zhihui;Ye Jia;Ren Yijun(Department of Traumatic Orthopedics&Microsurgery,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院创伤与显微骨科,430060

出　　处：《中华创伤骨科杂志》2021年第11期987-990,共4页Chinese Journal of Orthopaedic Trauma

基　　金：湖北省卫生厅面上项目(WJ2021M139);国家自然科学基金面上项目(81672154)。

摘　　要：目的探讨一期异位寄养大段游离骨块治疗开放性下肢骨缺损的临床疗效。方法回顾性分析2015年6月至2019年6月在武汉大学人民医院创伤与显微骨科采用一期异位寄养大段游离骨块治疗的11例GustiloⅢ型开放性下肢骨缺损患者资料。男8例,女3例;年龄18~57岁,平均35.3岁;受伤至手术时间为4~12 h,平均6.3 h;游离骨块大小为3~16 cm,平均8.7 cm。急诊一期行血管、神经吻合;游离骨块清洗消毒后寄养到血供丰富部位,其中寄养到大腿外侧9例,腹股沟2例;骨折外固定支架固定。二期行创面修复;三期行骨块回植,行钢板内固定6例,外固定支架固定5例。术后定期复查,X线检查评估骨折愈合情况。末次随访时采用Paley评分标准评定疗效,采用生活质量评价表(SF-36)评分评价功能,并记录并发症发生情况。结果所有患者术后获6~50个月(平均15.5个月)随访,随访期间无一例患者出现骨髓炎。2例外固定支架固定患者出现骨折延迟愈合,给予植骨+钢板内固定后,骨折顺利愈合。骨折愈合时间为5~12个月(平均8.5个月),总治疗时间为8~16个月(平均12.5个月)。末次随访时按照Paley评分标准评定疗效:优7例,良3例,差1例,优良率90.9%(10/11)。术后SF-36评分平均86.7分。结论一期异位寄养大段游离骨块治疗GustiloⅢ型开放性下肢骨缺损是可行的,具有手术方式简单、骨髓炎发生率低等优势。Objective To explore the efficacy of emergency ectopic embedment of a large extruded bone mass in the treatment of open lower limb bone defects.Methods From June 2015 to June 2019,11 patients were treated for open lower limb bone defects at Department of Traumatic Orthopedics&Microsurgery,Renmin Hospital of Wuhan University by primary ectopic embedment of a large extruded bone mass.They were 8 males and 3 females,aged from 18 to 57 years(mean,35.3 years).The time from injury to operation ranged from 4 to 12 hours(mean,6.3 hours).The size of free bone mass ranged from 3 to 16 cm(mean,8.7 cm).At the emergency primary stage,following vascular and nerve anastomosis,large extruded bone masses were embedded ectopically to the sites with rich blood supply after cleaning and disinfection.The embedment was lateral to the thigh in 9 cases and in the groin in 2 cases.Wound repair was performed at the second stage,and bone replantation at the third stage,followed by internal plate fixation in 6 cases and external fixation in 5 cases.Fracture union was evaluated by regular X-ray follow-ups.At the last follow-up,Paley score was used to evaluate the curative outcomes,SF-36 score to evaluate functional recovery,and complications were recorded.Results All patients were followed up for 6 to 50 months(mean,15.5 months).Follow-ups observed no osteomyelitis.Fracture union was delayed in the 2 cases with external fixation but eventually achieved after bone graft and internal fixation.All fractures united after 5 to 12 months(mean,8.5 months).The total treatment time ranged from 8 to 16 months(mean,12.5 months).According to the Paley scores at the last follow-up,7 cases were excellent,3 good and one was poor,giving an excellent to good rate of 90.9%(10/11).The SF-36 scores for the postoperative quality of life averaged 86.7.Conclusion Emergency ectopic embedment of a large extruded bone mass is a feasible treatment for open lower limb bone defects,with advantages of simplicity in operation and a low incidence of osteomyelitis.

关 键 词：下肢骨 移植 异位 骨折 开放性 游离组织移植物 

分 类 号：R687.3[医药卫生—骨科学]