采用体外制作骨水泥填塞物方式应用诱导膜技术修复上肢骨缺损

Application of the inducted membrane technique for repair of bone defect of upper limb through fabrication of bone cement spacer in vitro

目的分析采用体外制作骨水泥填塞物方式应用诱导膜技术修复上肢骨缺损的疗效。方法自2009年1月至10月采用体外制作骨水泥填塞物方式应用诱导膜技术修复32例上肢骨缺损患者。非感染骨缺损10例,感染性骨缺损22例。骨缺损长度1.0〜6.0cm,平均3.1 cm;节段性骨缺损23例,部分骨缺损9例。部位:桡骨7例,尺骨和胧骨各3例,尺骨与桡骨同时2例,指骨5例,掌骨7例,指骨与掌骨同时3例,腕骨2例。根据不同情况,体外制作圆柱体、块状或鹅卵石和珠链等多种形态骨水泥填塞物,凝固冷却后植入骨缺损处。记录骨愈合和并发症情况。末次随访上肢功能恢复采用DASH上肢功能调查表评价。结果第一阶段术后1例感染性骨缺损需要再次扩创。间隔平均10.3周(7~14周)行第二阶段手术,无取出困难和诱导膜损伤性缺损。术后随访12〜48个月,平均16.7个月,尺骨和掌骨各1例骨不连需要再次植骨才愈合,2例延迟愈合,临床愈合时间为2〜9个月,平均3.7个月,2例感染性骨缺损骨愈合后感染复发。末次随访无固定器断裂和再骨折,邻近关节功能恢复优18例,良9例,可5例;优良率84.38%。结论体外制作骨水泥填塞物应用诱导膜技术修复上肢骨缺损,不会发生填塞物取出困难和诱导膜损伤性缺损,并发症少,效果满意。

Objective To analyze the efficacy of using the inducted membrane technique for repair of bone defect of upper limb through fabrication of bone cement spacer in vitro.Methods From January to October 2009,32 patients with upper limb bone defects were repaired with the inducted membrane technique through fabrication of bone cement spacer in vitro.There were 10 cases of non-infectious bone defect and 22 cases of infectious bone defect.The length of bone defect was 1.0 to 6.0 cm,with an average of 3.1 cm.There were 23 cases of segmental bone defect and 9 cases of partial bone defect.Location:radius in 7 cases,ulna in 3 cases,humerus in 3 cases,ulna and radius in 2 cases,finger in 5 cases,metacarpal in 7 cases,finger and metacarpal in 3 cases and wrist in 2 cases.According to different conditions,various forms of bone cement spacer such as cylinder,block or pebble and bead chain were made in vitro,and implanted into the bone defect after solidification and cooling.The bone healing and complications were recorded.The recovery of upper limb function in the last follow-up was evaluated by DASH upper limb function questionnaire.Results One case of infectious bone defect needed to be expanded again after the first stage of operation.The second stage operation was performed at an average interval of 10.3 weeks(ranged,7 to 14 weeks).There was no difficulty in removal and induced membrane damage.The postoperative follow-up ranged from 12 to 48 months,with an average of 16.7 months.One case of nonunion of ulna and one of metacarpal bone needed bone grafting again to heal,and 2 cases delayed healing.The clinical healing time was 2 to 9 months,with an average of 3.7 months.The infection recurred after bone healing in 2 cases of infectious bone defect.In the last follow-up,there was no fracture or refracture of fixator.The functional recovery of adjacent joints was excellent in 18 cases,good in 9 cases and fair in 5 cases.The excellent and good rate was 84.38%.Conclusion The use of the inducted membrane technique for repair of bone defect of upper limb through fabrication of bone cement spacer in vitro will not lead to difficult removal of spacer and induced membrane damage defect,with less complications and satisfactory effect.