带肌蒂或血管蒂髂骨瓣移植修复股骨干骨缺损

IMMEDIATE REPAIRING OF THE BONE DEFECT OF FEMUR SHAFT WITH ILIAC BONE GRAFTING WITH MUSCLE PEDICLE OR VASCULAR PEDICLE

目的:采用肌蒂或血管蒂骨瓣一期修复枪伤性骨缺损的疗效分析。方法:自1985年以来,共有15例股骨干枪伤性骨缺损,采用缝匠肌肌蒂骨瓣或旋股外动脉升支髂骨瓣移植方法,一期予以修复。依据 Winqust 和 Hansen 对股骨干粉碎性骨折分类,Ⅲ型骨折12例,Ⅳ型3例。右侧股骨干10例,左侧股骨干5例。结果:经术后3～24个月随访,骨折愈合良好,平均愈合时间16周。膝关节伸屈范围100～132度,平均125度。结论:缝匠肌肌蒂骨瓣或旋股外动脉升支血管蒂骨瓣切取容易,不需吻合血管骨缺损处可一期获得具有独立血供骨瓣移植,并可充填死腔,改善局部血液循环,加速骨愈合。

Objective:To repair the bone defect from gunshot wounds immediately with iliac bone graft with muscle pedicle or vascular pedicle.Methods:Fifteen bone defects of femur shaft from gunshot wounds of 15 patients have been repaired immediately with iliac bone graft with sartorius mus- cle pedicle or ascending branch of lateral femoral circumflex artery pedicle since 1985.There were 13 male patients and 2 female patients with an age range of 18 to 50.Of the 15 fractured,12 were classified as Winquis-Hansen type Ⅲ and 3 were type Ⅳ.Results:All of the patients were followed up for a period of 3 to 24 months and had a excellent bone union.The mean time to bone union was 16 weeks.The mo- tion range of knee was 100 to 132;with an average of 125.Conclusion:Iliac bone graft with sartorius muscle pedile or ascending branch of lateral femoral circumflex artery pedicle could be resected easi- ly.The vascularized iliac bone with independent blood supplies filled up the defected area of bone and improved the blood supplies of the local regions,thus accelerating bone union.