膜诱导联合皮瓣移植修复长段骨缺损并软组织缺损

文题释义：骨诱导膜技术：包含体内形成诱导和诱导膜内植骨2个阶段，其中体内形成诱导膜首先行骨缺损部位彻底清创，依据骨折具体状况选取合适固定方式对骨折行稳定固定，采用聚甲基丙烯酸甲酯骨水泥填充骨缺损部位，感染性骨缺损则依据细菌培养药敏结果或经验采用含敏感抗生素骨水泥。该术后6-8周纵行切开诱导膜结构，小心去除骨水泥，采用钻头或骨锉去除两侧骨端和髓腔硬化骨，促进植骨融合，于骨膜内填充自体松质骨，缝合诱导膜，预防移植骨重吸收。 Iliazarov外固定牵张成骨：经过应力牵拉刺激加速骨折断端间充质干/祖细胞分化增殖，加速生成新骨与肢体重建，在修复骨缺损时还可恢复肢体长度完成骨折断端加压愈合。但Iliazarov外固定牵张成骨需要长时间固定，技术操作复杂，治疗周期长，费时费力。 背景：采用膜诱导技术治疗长段骨缺损具有并发症少、治疗效果显著且操作简便等优势，既往研究多采用该技术治疗软组织条件较好的骨缺损患者，对于骨缺损且软组织缺损面积较大或者伴随感染等患者的研究较少。 目的：分析膜诱导技术联合皮瓣移植修复长段骨缺损并软组织缺损的疗效。 方法：选择2016年10月至2018年8月南华大学附属南华医院收治的长段骨缺损合并软组织缺损患者15例，平均年龄(47.15±8.16)岁，创面软组织缺损面积5.1 cm×3.4 cm至21.8 cm×9.4 cm，骨缺损长度5.8-19.5 cm，平均(11.4±2.3) cm。对于创面轻度污染者行清创、骨折外固定、骨缺损区域骨水泥填塞，局部带蒂皮瓣或游离皮瓣覆盖皮肤创面；对于创面感染患者，先予封闭式负压引流治疗，待感染控制后再填充骨水泥及皮瓣手术。一期术后8-12周行二期植骨手术，术后随访12个月。试验获得南华大学附属医院伦理委员会批准。 结果与结论：①创面轻度污染的9例患者，清创后固定外固定架、填充骨水泥和皮瓣移植修复软组织缺损，均未发生感染；②6例感染患者清创封闭式负压引流一二周完全控制感染后进行填充骨水泥和皮瓣手术，创面愈合；③15例患者在骨缺损二期植骨以后均骨性愈合，愈合时间在8-12个月间，平均(9.18±2.10)个月；④结果表明，膜诱导技术联合皮瓣移植可有效治疗长段骨缺损并软组织缺损。 ORCID: 0000-0002-6182-9993(陈彦名) 中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

Skin flap transplantation combined with membrane induction technique for repair of long bone defects and soft tissue defects

BACKGROUND: Membrane induction technique for treating long bone defects has advantages of few complications, significant treatment efficacy and ease in operation. In previous studies, membrane induction technique was used to treat bone defect patients with good cartilage tissue, but there are few reports regarding bone defects with large area of cartilage tissue defect or accompanying infection. OBJECTIVE: To analyze the efficacy of flap transplantation combined with membrane induction technique for repairing long bone defects and soft tissue defects. METHODS: Fifteen patients with long bone defects and soft tissue defects who were treated in Affiliated Nanhua Hospital, University of South China from October 2016 to August 2018 were selected. They were aged(47.15± 8.16) years. The soft tissue defect area was 5.1 cm × 3.4 cm-21.8 cm × 9.4 cm. The length of bone defect was 5.8-19.5 cm, with an average of(11.4± 2.3) cm. The patients with mildly polluted wounds underwent debridement, external fixation of fracture, and filling bone cement in the bone defect area. Wounds were covered with local pedicle flaps or free flaps. Wound infection patients underwent vacuum sealing drainage, bone cement filling and flap surgery after infection was controlled. The second graft surgery was performed at 8 to 12 weeks after primary intention, and patients were followed up for 12 months. This study was approved by the Institutional Ethics Committee of Affiliated Nanhua Hospital, University of South China. RESULTS AND CONCLUSION:(1) Nine patients with mildly contaminated wounds were treated with external fixation after debridement, bone cement filling and flap transposition. No infection occurred.(2) Six patients with infection were treated with vacuum sealing drainage for 1 to 2 weeks. After the infection was controlled completely, bone cement filling and flap transplantation were conducted. All wounds were healed.(3) Fifteen patients achieved bone healing after second bone grafting. The healing time was between 8 and 12 months, with an average of(9.18± 2.10) months.(4) These results suggest that skin flap transplantation combined with membrane induction technique can effectively treat patients with long bone defects and soft tissue defects.