摘要
背景:采用膜诱导技术治疗长段骨缺损具有并发症少、治疗效果显著且操作简便等优势,既往研究多采用该技术治疗软组织条件较好的骨缺损患者,对于骨缺损且软组织缺损面积较大或者伴随感染等患者的研究较少。目的:分析膜诱导技术联合皮瓣移植修复长段骨缺损并软组织缺损的疗效。方法:选择2016年10月至2018年8月南华大学附属南华医院收治的长段骨缺损合并软组织缺损患者15例,平均年龄(47.15±8.16)岁,创面软组织缺损面积5.1 cm×3.4 cm至21.8 cm×9.4 cm,骨缺损长度5.8-19.5 cm,平均(11.4±2.3)cm。对于创面轻度污染者行清创、骨折外固定、骨缺损区域骨水泥填塞,局部带蒂皮瓣或游离皮瓣覆盖皮肤创面;对于创面感染患者,先予封闭式负压引流治疗,待感染控制后再填充骨水泥及皮瓣手术。一期术后8-12周行二期植骨手术,术后随访12个月。试验获得南华大学附属医院伦理委员会批准。结果与结论:①创面轻度污染的9例患者,清创后固定外固定架、填充骨水泥和皮瓣移植修复软组织缺损,均未发生感染;②6例感染患者清创封闭式负压引流一二周完全控制感染后进行填充骨水泥和皮瓣手术,创面愈合;③15例患者在骨缺损二期植骨以后均骨性愈合,愈合时间在8-12个月间,平均(9.18±2.10)个月;④结果表明,膜诱导技术联合皮瓣移植可有效治疗长段骨缺损并软组织缺损。
BACKGROUND: Membrane induction technique for treating long bone defects has advantages of few complications, significant treatment efficacy and ease in operation. In previous studies, membrane induction technique was used to treat bone defect patients with good cartilage tissue, but there are few reports regarding bone defects with large area of cartilage tissue defect or accompanying infection. OBJECTIVE: To analyze the efficacy of flap transplantation combined with membrane induction technique for repairing long bone defects and soft tissue defects. METHODS: Fifteen patients with long bone defects and soft tissue defects who were treated in Affiliated Nanhua Hospital, University of South China from October 2016 to August 2018 were selected. They were aged(47.15± 8.16) years. The soft tissue defect area was 5.1 cm × 3.4 cm-21.8 cm × 9.4 cm. The length of bone defect was 5.8-19.5 cm, with an average of(11.4± 2.3) cm. The patients with mildly polluted wounds underwent debridement, external fixation of fracture, and filling bone cement in the bone defect area. Wounds were covered with local pedicle flaps or free flaps. Wound infection patients underwent vacuum sealing drainage, bone cement filling and flap surgery after infection was controlled. The second graft surgery was performed at 8 to 12 weeks after primary intention, and patients were followed up for 12 months. This study was approved by the Institutional Ethics Committee of Affiliated Nanhua Hospital, University of South China. RESULTS AND CONCLUSION:(1) Nine patients with mildly contaminated wounds were treated with external fixation after debridement, bone cement filling and flap transposition. No infection occurred.(2) Six patients with infection were treated with vacuum sealing drainage for 1 to 2 weeks. After the infection was controlled completely, bone cement filling and flap transplantation were conducted. All wounds were healed.(3) Fifteen patients achieved bone healing after second bone grafting. The healing time was between 8 and 12 months, with an average of(9.18± 2.10) months.(4) These results suggest that skin flap transplantation combined with membrane induction technique can effectively treat patients with long bone defects and soft tissue defects.
作者
陈彦名
刘鸣江
谢松林
刘昌雄
宋剑刚
Chen Yanming;Liu Mingjiang;Xie Songlin;Liu Changxiong;Song Jiangang(Department of Hand and Foot Surgery,Affiliated Nanhua Hospital,University of South China,Hengyang 421002,Hunan Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2020年第16期2551-2555,共5页
Chinese Journal of Tissue Engineering Research
基金
湖南省卫生计生委科研计划课题(A2017018)，项目负责人：刘鸣江~~
关键词
长段骨缺损
软组织缺损
膜诱导技术
皮瓣移植
创面感染
外固定架
骨水泥
骨性愈合
long bone defect
soft tissue defect
membrane induction technique
flap transplantation
wound infection
external fixators
bone cement
bone healing
作者简介
陈彦名,男,1983年生,湖南省衡阳市人,汉族,硕士,副主任医师,主要从事复杂创面的显微修复方面的研究;通讯作者:刘鸣江,教授,主任医师,南华大学附属南华医院手足外科,湖南省衡阳市421002。
