Calkins M S, Burkhalter W, Reyes F
J Bone Joint Surg Am. 1987 Jan;69(1):19-27.
We treated twenty-two consecutive patients for an open fracture and segmental loss of bone in the upper extremity by delayed insertion of a graft of iliac corticocancellous bone. All of the wounds were left open and healed by secondary intention. Sixteen patients (nineteen grafts) had long-term follow-up. Ten injuries were secondary to a gunshot wound. The ten patients (twelve grafts) who had an injury to the hand were followed for an average of 24.1 months. No patient in this group had an infection, and all had primary union after an average of 13.3 weeks. Nine had a satisfactory result. The other six patients (seven grafts) had an injury to the arm or forearm and were followed for an average of 30.2 months. There were four non-unions, one refracture, and no persistent infections. The final result was satisfactory in five and unsatisfactory in one patient. Fourteen of the nineteen grafts were inserted within seventeen days after the initial injury. All nine of the grafts in the hand that were inserted early did well, but three of the other five (in the arm or forearm) became infected. The method that was used in the patients who had an open injury of the hand allowed early active motion and quick rehabilitation. The exposed cortical bone was not prone to infection. The technique has limited application in patients who have an open injury of the arm or forearm because of a high incidence of complications.
我们采用延迟植入髂骨皮质松质骨 graft 的方法，连续治疗了 22 例上肢开放性骨折并伴有节段性骨缺损的患者。所有伤口均敞开，通过二期愈合。16 例患者（19 块 graft）进行了长期随访。10 例损伤继发于枪伤。手部受伤的 10 例患者（12 块 graft）平均随访 24.1 个月。该组患者均未发生感染，平均 13.3 周后均实现一期愈合。9 例结果满意。其他 6 例患者（7 块 graft）手臂或前臂受伤，平均随访 30.2 个月。发生了 4 例骨不连、1 例再骨折，无持续性感染。最终结果 5 例满意，1 例不满意。19 块 graft 中有 14 块在初次受伤后 17 天内植入。手部早期植入的所有 9 块 graft 情况良好，但其他 5 块（手臂或前臂）中有 3 块发生感染。用于手部开放性损伤患者的方法允许早期主动活动和快速康复。暴露的皮质骨不易感染。由于并发症发生率高，该技术在手臂或前臂开放性损伤患者中的应用有限。
