大段(块)感染骨异位预构骨皮瓣修复创伤后骨及皮肤软组织缺损的应用  

Application of large segment(block)infected bone heterotopic prefabricated bone flap for repairing bone and skin soft tissue defects after trauma

作　　者：陈达 周明武[2] CHEN Da;ZHOU Mingwu(Department of Orthopedics,Nanyang Central Hospital,Nanyang,Henan,473000,China)

机构地区：[1]南阳市中心医院骨科,河南南阳473000 [2]中国人民解放军联勤保障部队第988医院全军创伤骨科中心,河南郑州450000

出　　处：《实用手外科杂志》2024年第2期168-173,共6页Journal of Practical Hand Surgery

摘　　要：目的探讨大段(块)感染骨异位寄养,血管化完成后原位回植,治疗严重创伤后骨及皮肤软组织缺损的临床效果。方法回顾性分析2012年3月-2022年3月收治的14例严重大段(块)骨感染伴皮肤软组织缺损患者病例资料,游离骨段(块)长度6.5~17.0 cm,平均11.25 cm。将游离的大段(块)感染骨体外灭菌后,异位寄养于股直肌与股外侧肌间隙,预构带血管蒂的骨皮瓣,同时对原位创面进行抗感染治疗,待感染骨血管化完成后原位回植修复骨及皮肤软组织缺损,并按照Paley提出的评价标准评定疗效。结果14例术后随访20~60个月,平均28.9个月,回植骨未见再感染,皮瓣创面愈合良好,愈合时间0.5~6个月,平均1.3个月;X线片提示回植骨愈合时间3~19个月,平均8.7个月。患者均恢复负重行走功能,开始负重行走时间为术后5~12个月,平均7.6个月。按照Paley等骨与功能分级方法评定疗效,骨性愈合结果评价:优9例,良5例,优良率100%;功能恢复结果评价:优7例,良6例,一般1例,优良率92.8%。结论将大段(块)感染骨异位寄养预构骨皮瓣,血管化完成后二期原位回植修复严重创伤后骨及皮肤软组织缺损临床疗效满意,既充分利用废弃的感染骨,同时可以减少外源性植骨带来的问题,避免截肢,为临床治疗严重复杂的大段(块)骨感染伴皮肤软组织缺损提供一种新的方法。Objective To investigate the clinical effect of ectopic foster care of large segment(block)infected bone and bone transplatation after vascularization for the treatment of bone and skin soft tissue defects after severe trauma.Methods A retrospective analysis was conducted on 14 patients with severe large segment(block)bone infection with skin and soft tissue defects from March 2012 to March 2022.The length of the free bone segment(block)was 6.5~17.0 cm,and the length was 11.25 cm.After sterilization of Infected large segment(block)bone in vitro,ectopically fostered it in the intermuscular space between femoral rectus muscle and the vastus lateralis muscle,prefabricated cular pedicle bone flap,anti-infection treatment was performed in the in situ wound,after the infected bone vascularization in situ implant to repair bone and skin and soft tissue defect,and put forward the evaluation standard of evaluation according to Paley curative effect.Results The follow-up time of 14 patients ranged from 20 to 60 months,with an average of 28.9 months.No re-infection was found in the patients after the surgery,and the flap wound healed well,with a healing time of 0.5 to 6 months,with an average of 1.3 months.X-ray suggested that the healing time of bone graft was 3~19 months,8.7 months on average.All patients recovered weight-bearing walking function,and the time of starting weight-bearing walking was 5-12 months after the operation,7.6 months on average.According to Paley and other methods of bone and function grading,the curative effect was evaluated.Functional results:excellent in 7 cases,good in 6 cases,general in 1 case,excellent in 92.8%.Conclusion Large segment(block)infection ectopic bone foster structural bone flap,vascularization in situ and implant after the completion of phase ii in repairing skin and soft tissure defect after severe trauma of bone and clinical curative effect is satisfied,makes full use of abandoned infected of bone,at the same time can reduce exogenous bone graft problems,avoid amputation,provid

关 键 词：骨感染 骨缺损 皮肤软组织缺损 血管化 

分 类 号：R658[医药卫生—外科学]