皮瓣加3D打印微孔钛(钽)假体治疗下肢软组织缺损伴大段骨缺损  

Flap combined with 3D printed microporous tianium(tantalum)prosthesis in the treatment of lower extremity soft tissue defect with large bone defect

作　　者：徐永清 范新宇 王腾 浦绍全 李川 蔡兴博 崔轶 何晓清 林玮 吴一芃 石健 李霞 赵德伟 刘保一[2] 冯强 XU Yongqing;FAN Xinyu;WANG Teng;PU Shaoquan;LI Chuan;CAI Xingbo;CUI Yi;HE Xiaoqing;LIN Wei;WU Yipeng;SHI Jian;LI Xia;ZHAO Dewei;LIU Baoyi;FENG Qiang(Institute of Orthopaedic Trauma,920th Hospital of Joint Logistics Support Force,Kunming 650032,China;Department of Orthopaedics,Zhongs han Hospital Affiliated to Dalian University,Dalian,Liaoning Province 116001,China;Yunnan Zengcai Jiawei Technology Co.,Ltd.,Kunming 650000,China)

机构地区：[1]联勤保障部队第九二○医院全军创伤骨科研究所,昆明650032 [2]大连大学附属中山医院骨科,辽宁大连116001 [3]云南增材佳唯科技有限公司,昆明650000

出　　处：《中华显微外科杂志》2022年第1期21-27,共7页Chinese Journal of Microsurgery

基　　金：国家自然科学基金(81772367);国家重点研发计划项目(2017YFC1103900);云南省创伤骨科临床医学中心(ZX20191001);云南省重点新产品开发计划(2015BC004);联勤保障部队第九二医院院内科技计划助推计划(2020YGD06);联勤保障部队第九二医院院内科技助推计划(2020YGB04)

摘　　要：目的观察皮瓣加3D打印微孔钛(钽)假体治疗下肢软组织缺损伴大段骨缺损的治疗效果.方法2019年1月-2020年12月,收治2例足背软组织大面积缺损伴大段跖骨骨缺损,4例小腿软组织缺损伴大段胫骨骨缺损的患者,软组织缺损面积5.0 cm×8.0 cm~15.0 cm×10.0 cm,骨缺损长度3.8~7.0(平均5.75)cm.一期先用万古霉素骨水泥填充跖骨骨缺损或胫骨骨缺损,同时2例足部采用吻合血管的股前外侧皮瓣(ALTF)修复软组织缺损,4例小腿采用局部筋膜皮瓣转位修复,皮瓣大小6.0 cm×8.5 cm~16.0 cm×11.0 cm.术后2~7个月,采用个体化设计的微孔假体(微孔钛5例、微孔钽1例)修复骨缺损.术后观察伤口愈合情况、跖骨及胫骨骨断端与3D打印微孔钛(钽)假体骨整合情况及行走情况.随访6~25(平均12.7)个月.结果5例患者伤口愈合良好,术后2个月开始站立,3个月开始扶拐行走,5~6个月脱拐行走;骨整合良好;1例糖尿病患者术后3个月足部伤口感染,微孔钛假体取出并更换万古霉素骨水泥后,伤口愈合,恢复行走.结论皮瓣加3D打印微孔钛(钽)假体治疗下肢软组织缺损伴大段骨缺损,是一种有效的、促进患者更早下地的方法,其远期疗效需要进一步观察,如何降低假体感染率需要进一步探索.Objective To investigate the ffect of flap combined with 3D printed microporous tianium(anta-lum)prosthesis in the treatment of lower extremity soft tssue defect with large bone defect.Methods From January 2019 to December 2020,2 patients with large soft tissue defects on dorsal foot together with large metatarsal bone de-fect and 4 patients with soft tissue defects of calf with large tibial bone defect were treated.The areas of soft tissue defect were 5.0 cmx8.0 cm-15.0 cm×10.0 cm.The length of the bone defect were 3.8 cm to 7.0 cm,5.75 cm in aver-age.In the first stage,metatarsal bone defect or tibial bone defect was flld with vancomycin blended bone cement,meanwhile,soft tissue defect was repaired with anterolateral femoral fap(ALTF)with vascular anastomosis in 2 cases of feet,and local fascia flap was trans-positioned in 4 cases of lower extremity defects.The sizes of repairing flap were 6.0 cmx8.5 cm-16.0 cmx11.0 cm.Two to 7 months after the initial surgery,the customer designed microporous tita-nium prosthescs were used(5 cases with microporous titanium and 1 with microporous tantalum)to repair the bone de-fects.The wound healing,the integration of metatarsal and tibial fractures with 3D printed microporous titanium(tanla-lum)prostheses,and the walking condition were observed after surgery.The follow-up lasted from 6 to 25 months,with an average of 12.7 months.Results The wound healing in 5 patients was good.The patients stood on the foot in 2 months after surgery,started to walk with the assistance of crutch in 3 months after surgery,and took walk without as-sistance in 5-6 months after surgery.Good osscous integration were achieved.One diabetic patient had infection of foot wound 3 months after surgery.After removal of microporous titanium prosthesis and replacement of vancomyeinblended interstitial substance of bone cement,the wound healed and the patient resumed walking.Conclusion It is an effective method to encourage the patients to take early ambulation after the surgery for lower extremity soft tis

关 键 词：外科皮瓣 假体 3D打印微孔钛(钽) 下肢 软组织缺损 骨缺损 

分 类 号：R658.3[医药卫生—外科学]