异体骨及皮瓣移植修复小腿大段骨与皮肤缺损后的功能恢复效果

Therapeutic effect of the transplantation of bone allograft and flap for repairing bone and skin defects of legs and functional recovery

目的:报道应用异体骨和皮瓣移植及支架外固定治疗小腿骨和皮肤缺损的临床效果,并探讨异体骨移植出现的并发症及其处理方法。方法:选择1996-02/2003-02收治的小腿感染性大段骨缺损并皮肤缺损的患者39例,均为外伤造成小腿胫腓骨开放粉碎性骨折及包括皮肤在内的多种组织损伤。其中胫骨缺损长度为7～23cm,皮肤缺损面积为7cm×6cm～28cm×18cm。将患者分为一期修复组19例,先行扩创,再二期行异体骨及皮瓣移植;二期修复组20例,清创后一期行异体骨与皮瓣移植。两组均采用深低温冷冻异体胫骨及带骨膜皮瓣移植、可调式支架外固定,修复小腿感染性骨缺损并皮肤缺损。下肢功能评定参照Enneking系统。结果:39例患者平均随访2年7个月,全部进行结果分析。①患者肢体功能评价结果:一期修复组平均27.40分,肢体功能恢复91%。二期修复组平均28分,肢体功能恢复93%。两组患者术后6周可带外固定支架行走,术后6～8个月可拆支架行走。②移植皮瓣类型成活情况:两组患者共35例皮瓣成活,4例皮瓣远端部分坏死,经二次皮瓣修复,创面愈合。③异体骨与宿主骨干的愈合情况:术后X射线复查,移植的异体骨对位对线好,术后1月骨痂生长,6月后植入的异体骨骨性愈合。④主要并发症:一、二期修复组各2例皮瓣远端部分坏死、1例排斥反应,二期修复组1例外固定松动。结论:应用异体骨及带骨膜的复合皮瓣移植修复,取材方便,可加速骨的愈合,缩短疗程,恢复行走功能,是修复小腿感染性大段骨缺损并皮肤缺损的有效方法。

AIM： To report the clinical effect of Massive Frozen allograft and flap transplantation as well as external fixation of scaffold in the treatment of bone and skin defect injury, and investigate postoperative complications and the therapy methods. METHODS： Totally 39 patients with infective segmental bone and skin defects of the legs who were received the treatment from February 1996 to February 2003 were recruited. They all had tibiM and fibular open splintered fracture and the injury of many tissues including the skins of the legs caused by trauma. The defect length in tibia of those patients was from 7 to 23 cm; the defect area of the skin was from 7 cm×6 cm to 28 cm×18 cm. 19 patients in the one-stage repair group were debrided, then repaired by transplantation of allograft and flaps; 20 patients in the two-stage repair group were immediately repaired while being debrided. In the both groups, infective bone and skin defect were repaired by using frozen tibia of allograft and flaps With periosteum,fixed by adjustable external fixator. The lower-limb function was evaluated according to Enneking system. RESULTS： Totally 39 patients were followed up for 2 years and 7 months, and all the patients entered the stage of result analysis. ①Evaluation resuits of limb function： It was 27.40 points in the one-stage repair group, and 91% of the limb function recovered. It was 28 points in the two-stage repair and 93% of the limb function recovered. The patients could walk at the 6^th week after operation with external fixation device and at the 6^th to 8^th month postoperatively wben removing external fixation device.②Survival of transplanted flaps： All flaps survived well in 35 cases. Distal segment of flaps were necrosis in 4 cases and healed by repairing with another flap.③ Healing of allograft and host bone： After operation, the repaired bone and joint showed normal position by X-ray films. Bony callus grew 1 month after operation. All gafted allograft had showed bone union 6 months after operation.④Main complications： Distal segment of flaps were necrosis in 2 cases, rejection in 1 case and loosening of external fixation in 1 case in one-stage and two-stage repair group, separately. CONCLUSION： Massive Frozen allograft and the complex flaps with periosteum are easy to be found. It is an effective method to repair infective segmental bone and skin defect of the legs due to its advantages of accelerating osteal healing, shortening the course of treatment and recovering walking function.