应用自体游离骨塞技术急诊修复截肢残端骨创面

The Application of Autologous free Bone Plug Technology in Emergency Repair of Amputation Stump Bone Wound

目的：研究利用截肢后废弃肢体的游离骨组织修复残端创面的疗效。方法：2010牟3月一2012年3月我们利用残肢游离骨塞技术急诊修复截肢后残端6例。确定截骨平面后，在其内及外侧保留骨膜瓣，用摆动锯截骨至骨面渗血，常规打磨处理残骨边缘。在清创后的离断肢的正常骨质上设计骨塞大小。剔除骨膜后制备成类圆锥型骨塞，其底面为骨皮质，4周为松质骨。其基底部则按截骨的横截面修整成一略带弧形的骨垫，塞入残端髓腔，修整骨塞基底部后，用骨膜瓣闭合残端骨髓腔。将事先设计好的软组织瓣依次包埋残端，皮下放置胶片引流，大量棉垫包扎，并石膏固定（硬包扎）处理。结果：4例患者创面甲级愈合，拆线出院。2例患者术后出现创缘下积液，予扩创换药后伤后20～25天创面愈合。患肢随访3～6个月，残端无窦道形成，伤后1年装配假肢残端皮肤无溃疡压疮，外形良好。结论：应用截肢肢体游离骨塞技术修复残端骨创面疗效满意。

Objective：Study the efficacy of free bone plug of discarded limbs after amputation in repairing stump bone wound. Mcth- ods： From March 2010 to March 2012, we emergency repaired 6 cases of amputation stump bone wound in autologous free bone plug tech- nology,5 males and 1 female,the age ranged from 21 to 53 years old, average 35 years old. Causes of injuries： 5 cases of traffic accident injury, 1 cases of machine strangulation injury. 1 case of upper limb amputation, and 4 cases of lower limb amputation. Special examina- tion： 1 cases of distal forearm damage;2 cases of thigh supracondylar and intercondylar comminnted fracture , femoral artery nerve de- structive injury and part of the defect;2 cases of the lower leg tibia and fibula comminuted fractures and popliteal artery injury; 1 cases of knee remote defect. After determining the osteotomy plane, retained inner and outer periosteal flap, osteotomy to the bone surface bleed- ing by swing saws, sanded the edges of the bones. According the debridement amputation bone surface to design the bone plug size, made class cone type bone plug after removing periosteum, the bone plugs bottom of the cortical bone, surrounded by cancellous bone. Its base is trimmed into a slightly curved bone pad according to the cross - section of the stump osteotomy, stuffed stump medullary cavity, used the periosteal flap closure stump marrow cavity after trim the bottom of the bone plug, Soft tissue flaps designed well in advance embedded stump in turn, placed film drainage in tbe subcutaneous , a large number of cotton pad dressing, plaster cast processing （ hard bandage）. Results： 4 patients wounds first class healing and stitches discharged, 2 patients postoperative wound edge effusion whose wound healing after 20 - 25 days dressing, Followed up for 3 - 6 months, all stump without sinus formation. 1 year after amputation, assembly prosthetic stump skin are good shape, no ulcers and pressure sores. Conclusion：The results were satisfactory of application amputated limb free bone plug technology to repair stump bone wounds.