阔筋膜包裹自体松质骨植骨治疗上肢骨缺损

Treatment of upper limb bone defects with autogenous cancellous bone graft wrapped by femoral fascia

目的探讨阔筋膜包裹自体松质骨植骨治疗上肢骨缺损的可行性和效果。方法自2011年6月至2016年12月,我们对12例上肢骨缺损患者采用阔筋膜包裹自体松质骨植骨+内固定治疗。骨缺损部位:肱骨3例,桡骨5例,尺骨4例。骨缺损长度2.5~6.0 cm,平均4.0 cm。结果切口延迟愈合1例,取骨区并发症2例。患者均获得随访,时间12~36个月,平均19个月。所有患者均骨愈合,临床愈合时间为2.5~4.0个月,平均2.9个月,无延迟愈合和骨不连发生,愈合率100%。移植区无深部感染、内固定断裂和再骨折。末次随访肢体功能恢复按DASH上肢功能调查表评价:优6例,良5例,可1例。结论阔筋膜供源丰富,取材方便;阔筋膜包裹自体松质骨植骨治疗上肢小段和大段骨缺损同样有效,手术操作简单,费用低,骨愈合快、愈合率高,功能恢复满意。

Objective To explore the feasibility and effect of autogenous cancellous bone graft wrapped by femoral fascia in the treatment of upper limb bone defects. Methods From June 2011 to December 2016, 12 patients with upper limb bone defects were treated with femoral fascia wrapping autogenous cancellous bone graft and internal fixation. Bone defect site: 3 cases in humerus, 5 cases in radius, and 4 cases in ulna. The length of bone defects ranged from 2.5 to 6.0 cm, with an average of 4.0 cm. Results Delayed wound healing occurred in 1 case and complications occurred in 2 cases. All the patients were follow-up for 12 to 36 months with an average of 19 months. Bone union occurred in all the patients. The clinical healing time ranged from 2.5 to 4.0 months, with an average of 2.9 months. No delayed union or nonunion occurred. The healing rate was 100%. There were no deep infection, internal fixation fracture and re-fracture in the transplantation area. At the last follow-up, limb function recovery was evaluated by DASH upper limb function questionnaire. The results were rated as excellent in 6 cases, good in 5 cases and fair in 1 case. Conclusion Femoral fascia has abundant sources and is convenient for harvesting. Femoral fascia wrapping autogenous cancellous bone graft for the treatment of upper limb bone defects is effective for small and large segmental defects. It has the advantages of simple operation, low cost, fast bone healing, high healing rate and satisfactory functional recovery.