带血管骨皮瓣移植治疗胫骨感染性骨不连.DOCVIP

临床医学论文-带血管骨皮瓣移植治疗胫骨感染性骨不连 ???????? 作者：张智，张成进，李忠，吕明，张尔坤 【关键词】? 感染 ???? 摘? 要：［目的］回顾总结带血管骨皮瓣移植治疗胫骨感染性骨不连的方法和疗效。［方法］从2002年8月～2004年8月，应用单边外固定架稳定骨折端，同时行带血管骨皮瓣移植治疗18例胫骨感染性骨不连，男15例，女3例，年龄18～51岁，平均34岁。清创后胫骨缺损3～8 cm，软组织缺损4 cm×3 cm～18 cm×9 cm。14例行带血管髂骨皮瓣移植修复，4例行带血管肩胛骨皮瓣移植修复，术后随访8～30个月，平均17个月。［结果］18例骨皮瓣全部成活，胫骨及软组织缺损Ⅰ期修复，外固定架固定牢固，获得骨性愈合时间8～13个月，平均10个月，3例出现外固定架钉道感染，1例发生取髂骨处疼痛。［结论］带血管骨皮瓣移植联合外固定架固定是治疗胫骨感染性骨不连行之有效的方法，Ⅰ期解决骨及软组织缺损的问题，促进骨的愈合。 ??? 关键词：骨皮瓣；? 移植；? 感染；? 骨折；? 不连接；? 外固定器 ?????? Abstract：［Objective］To describle the method and the clinical effect of vascularized? osteocutaneous flap grafting for the tibial infected nonunion.［Method］From August 2002 to August 2004,vascularized osteocutaneous flap grafting combined with extemal flxator immobilization was carried out to treat 18 cases of tibial infected nonunion, which involved 15 males and 3 females with an average of 34 years (ranged,18～51 years).The range of bone defect and soft tissue was 3～8cm and 4×3cm～18×9cm respectively.The groin osteocutaneous flap with the deep circumflex iliac vessels was 14 cases. The scapular osteocutaneous flap with the circumflex scapular vessels was 4 cases. The followup period ranged from 8~30 months with an average of 17 months.［Result］All the osteocutaneous flaps survived completely after operation.The bone and soft tissue defects were repaired at one setting.The external fixation apparatuses were steady.Eighteen cases achieved bonny union during the followup of average 10? months? with a range of 8 to 13 months.The recovery of function of the limb were satisfactory.［Conclusion］Vascularized osteocutaneous flap combined with external flxator immobilization can be effective alternative to treat tibial infected nonunion .The bone and soft tissue defects could be repaired at one setting. ??? Key words：Osteocutanous flap；? Transplantation；? Infection；? Fracture;? Nonunion；? External fixators ??? 感染性骨不连(infected nonunion)涉及感染和骨不连两大难题，常伴有软组织缺损，临床处理比较棘手。本院自2002年8月～2004年8月间共收治四肢骨不连患者186例，其中胫骨中下段感染性骨不连者2