筛网状筋膜包裹松质骨植骨治疗四肢骨折后骨缺损

Application of meshy fascia encapsulating cancellous bone graft in repair of bone defect after limb fractures

目的探讨筛网状筋膜包裹松质骨植骨治疗四肢骨折后骨缺损的效果。方法回顾分析2011年6月–2016年12月,采用筛网状筋膜包裹松质骨植骨治疗的21例外伤性四肢骨折后骨缺损患者临床资料。男13例,女8例;年龄14～64岁,平均40.1岁。骨缺损部位:肱骨3例,桡骨5例,尺骨4例,股骨2例,胫骨7例。原发骨折AO分型:A型2例,B型7例,C型12例。开放性骨折14例,闭合性骨折骨不连伴骨缺损7例。受伤至骨缺损修复时间为5～165 d,平均21.3 d。扩创后骨缺损长度2.5～6.5 cm,平均4.5 cm。结果手术时间86～130 min,平均101 min;术中出血量185～647 mL,平均316 mL。术后发生切口浅表感染1例,延期愈合2例;无神经血管损伤发生。21例均获随访,随访时间12～36个月,平均19个月。骨折临床愈合时间为2.5～7.0个月,平均5.4个月,无延迟愈合和骨不连发生,愈合率为100%。无深部感染或感染复发,无内固定物断裂和再骨折发生。末次随访时,骨缺损愈合分级均为优;患肢功能恢复分级为优12例、良7例、可2例,优良率90.5%。结论筛网状筋膜包裹松质骨植骨治疗四肢骨折后骨缺损具有筋膜取材及手术操作简便、无不良反应、费用低、效果满意等优点。

Objective To investigate the effectiveness of meshy fascia encapsulating cancellous bone graft inrepair of bone defect after limb fractures. Methods A clinical data of 21 cases of traumatic bone defect after limbfractures, who were treated with meshy fascia encapsulating cancellous bone graft between June 2011 and December 2016,was retrospectively analyzed. There were 13 males and 8 females, aged 14-64 years with an average of 40.1 years. Thelocation of bone defect included humerus in 3 cases, radius in 5 cases, ulna in 4 cases, femur in 2 cases, and tibia in 7 cases.AO classification of primary fractures were type A in 2 cases, type B in 7 cases, and type C in 12 cases. There were 14 casesof open fracture, and 7 cases of closed fracture associated with bone defect. The time from injury to bone defect repair was5-165 days (mean, 21.3 days). The length of bone defect was 2.5-6.5 cm with an average of 4.5 cm. Results The operationtime was 86-130 minutes (mean, 101 minutes). The intraoperative blood loss was 185-647 mL (mean, 316 mL). One caseof superficial infection and 2 cases of delayed healing of incision occurred after operation, and no neurovascular injuryoccurred. All the 21 patients were followed up 12-36 months (mean, 19 months). The clinical healing time was 2.5-7.0 months (mean, 5.4 months); no delayed healing and nonunion occurred, the bony healing rate was 100%. There wasno deep infection, infection recurrence, broken of internal fixator, or refracture. At last follow-up, the grading of bonyhealing were all rated as excellent, and the functional recovery of the affected limb was excellent in 12 cases, good in7 cases, and fair in 2 cases with an excellent and good rate of 90.5%. Conclusion Meshy fascia encapsulating cancellousbone graft in repair of bone defect after limb fracture is characterized by easy to harvest fascia, simplicity of operation, noadverse reaction, lower cost, and satisfactory results.