骨膜瓣移位防治骨不连

Prevention and treatment of bone nonunion by transposition of periosteum flap

目的为预防和治疗骨不连提供一种实用方法。方法骨不连端去除硬化骨,打通髓腔,两端骨皮质表面凿成约2cm长粗糙面,骨不连间隙小于3mm者不需植骨,大于3mm者则行开槽嵌入式植骨。于骨折线的远端或近端设计一合适大小的骨膜瓣,以有较好血运的筋膜部位为蒂,其长宽比例和移位方法均参照筋膜蒂皮瓣移位术。用移位骨膜瓣将骨折线周径的2/3～3/4良好覆盖后,再将其两端与周围残存骨膜或筋膜缝合固定,对无条件形成合适骨膜瓣者,可将其骨膜行套袖状推进或于骨折线远近端各形成一短瓣交错移位。对有细小碎骨片缺失或易发骨不连部位,如胫骨下1/3、股骨髁上、肱骨干横断骨折等则不需处理髓腔,骨膜瓣移位方法相同。结果骨不连69例,易发延迟愈合及骨不连的骨折155例。经术后6个月～20年随访(平均3年),骨不连患者全部愈合,骨折病例均未发生骨不连。结论用带筋膜蒂骨膜瓣移位覆盖骨折线方法简便实用,可有效的促进骨折愈合预防和治疗骨不连。

Objective To investigate a feasible method to prevent and treat bone nonunion. Methods In treatment of nonunion, the sclerosis bone was removed and the medullary canal was opened. A rough bone surface 2 cm in length was chiseled at the bone ends. Bone grafting was not needed in the cases where the gap between bone ends was less than 3 mm. A proper periosteum flap with good blood supply was designed near the fracture line, and its length, width and the transplantation methods were designed according to the conventional requirements of transplantation of skin flap. After 2/3 to 3/4 of the circumference of the fracture line was covered by the periosteum flap, the flap was fixated by suturing with the residue end of the periosteum. In the cases where a periosteum flap was not feasible, the periosteum could be propelled by cuff appearance, or by interlacing transposition with the short flap formed near the fracture line. Results In the 204 cases which had been treated with the above methods in our department, 69 cases were nonunion, and the others were fractures at the sites of likely delayed union. All the cases were followed up for 6 months to 20 years (averaging 3 years). All the nonunion healed, and no delayed union or nonunion occurred in the fracture cases. Conclusion Transposition of fascia pedicel periosteum flap to cover the fracture gap can efficaciously prevent and treat nonunion.