摘要
目的 探讨诱导膜技术治疗骨缺损的影响因素和技术要点.方法 收集2008年1月至2014年11月应用诱导膜技术治疗20例骨缺损患者的病历资料,男15例,女5例;年龄13～69岁,平均38.5岁.感染性骨缺损16例,非感染性骨缺损4例.记录并发症情况,参照Paley方法分别评价骨缺损愈合和邻近关节功能,并采用自定标准对邻近关节活动度进行评价.结果 第一阶段术后1例因皮瓣缝合较紧,伤口逐渐裂开致骨水泥外露需行二次手术,其余均无感染或感染复发.第二阶段术中3例发生诱导膜损伤、缺损.所有患者均获得随访,随访时间12～50个月,平均19.7个月.所有骨缺损均愈合,临床愈合时间3.0～7.0个月（平均4.7个月）,3例诱导膜损伤、缺损者的临床愈合时间（平均6.0个月）长于无损伤、缺损者（平均4.6个月）.末次随访时骨缺损愈合分级均为优;邻近关节功能：优8例、良10例、可2例,优良率为90％;邻近关节活动度分级：优、良各8例,可、差各2例,优良率为80％.1例感染性骨缺损伴诱导膜损伤患者第二阶段术后6个月出现局部感染,保守治疗无效,再次手术后控制感染;另1例感染性骨缺损无诱导膜损伤患者第二阶段术后12个月出现局部感染,经保守治疗控制感染.其余患者术后无感染或感染复发,均无固定器断裂.结论 诱导膜技术治疗骨缺损具有操作简便、骨缺损愈合较快、愈合时间与骨缺损长度无相关性、并发症少等优点,但临床应用必须理解其治疗原理,重视其影响因素和技术要点,才能避免手术失误、减少并发症和提高疗效.
Objective To investigate the influencing factors and technical points of induced membrane technique for treatment of bone defect.Methods All of 20 patients of bone defect were treated by induced membrane technique in our hospital from January 2008 to November 2014,including 15 males and 5 females;aged 13-69,average 38.5;infectious bone defect in 16 cases and non-infectious bone defect in 4 cases.Record the complications,evaluate the healing of bone defect and functional recovery of adjacent joints by Paley method,respectively,and grade the range of movement （ROM） of adjacent joints by authors＆#39;s method.Results In the first stage of surgery,1 case needed a second operation as the wound gradually spitted and bone cement contaminated after tighten closure of the skin flap,while others had no infection or recurrence of infection.In the second stage of surgery,3 cases had induced membrane damage and defect.All were followed-up from 12 to 50 months （average 19.7 months）;all the bone defects healed,the clinical healing time was 3.0 to 7.0 months （average 4.7 months）.The healing time in the 3 cases with induced membrane damage and defect （average 6.0 months） was longer than that in patients without induced membrane damage and defect（average 4.6 months）.1 case of infectious bone defect with induced membrane damage and defect had local infection in 6 months after the second stage of surgery,for whom the conservative treatment was invalid but got controlled after second operation while 1 case of infectious bone defect without induced membrane damage and defect had local infection in 12 months after second stage of surgery,in whom the infection was controlled by the conservative treatment,the others had no infection or recurrence of infection,no broken of fixators noted;at the last follow-up,all the bone defect healing graded excellent,the functional recovery of the adjacent joints graded：excellent in 8 cases,good in 10 cases,and fair in 2 cases （the excellent and good rate was 90%）,the ROM of
作者
殷渠东
顾三军
芮永军
孙振中
吴永伟
沈友银
Yin Qudong Gu Sanjun Rui Yongjun Sun Zhenzhong Wu Yongwei Shen Youyin(Department of Orthopaedics, Wuxi No.9 People＇s Hospital, Wuxi 214062, China Department of Orthopaedics, Wuxi Rende Hospital, Wuxi 214000, China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2016年第20期1284-1293,共10页
Chinese Journal of Orthopaedics
关键词
四肢
创伤和损伤
感染
骨黏合剂
Extremities
Wounds and injuries
Infection
Bone Cements
