穿支骨膜瓣游离移植治疗难治性骨不连的疗效观察

THE EFFENCY OF USING THE PERIOSTEAL FLAP WITH PERFORATING BRANCHES IN TREATING REFRATRAY NONUNION

目的探讨穿支骨膜瓣游离移植治疗难治性骨不连的临床治疗效果。方法所有18例病人采用骨不连残端取出硬化骨、打通髓腔。骨不连间隙>3 mm的13例采用Feminster植骨法,植入髂骨骨片;骨不连间隙<3 mm的5例将骨端去除骨血管,变为毛糙状,骨碎屑填入间隙。切取大小适宜的带有骨膜监测皮岛的胫骨外侧穿支骨膜瓣游离移植于骨不连处。结果随访时间6～24个月,平均随访16.7个月。18例患者均获得骨性愈合,监测皮岛均成活,患者肢体功能恢复良好,无明显肢体短缩、关节活动受限、跛行等并发症,满意度高。结论应用穿支骨膜瓣游离移植治疗骨不连具有损伤小,术后恢复好的优点,是治疗骨不连的好方法,适合进行临床推广。

Objective To discuss the efficiency of the periosteal flap with perforating branches in treating refractory nonunion. Methods The sclerotic bones were removed from the nonunion, and the medullary cavity was opened up in all 18 patients. 13 patients whose nonunion gaps 〉 3 mm were treated by implanting the iliac bone pieces according to the Feminster law, and 5 patients whose nonunion gaps 〈 3 ram were treated by implanting bone fragments clumps after the end of the nonunion were treated by removing the bone blood vessels and became rough shape. Then, suitable size of the periosteal flap with perforating branches was cut, and it was planted in the nonunion of the fracture. Results All patients got the full follow - ups from 6 - 24 months, and the mean time was 16.7 months, all 18 patients achieved the bone union standards, and the skin island survived. Limb functions of the pa- tients recovered, with no complications such as significant shorting of the limb, anchylosis, limp of the legs and so on, which satisfied all patients. Conclusion The treatment the nonunion of the fracture in using the periosteal flap with perforating branches is a good option with the characters of small damages and better recovery of the patients, and thus is highly recommended.