Fan Jinzhu, Cong Fei, Ren Xiaoyu, Zhang Ke, Song Tao
Department of Bone Microsurgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2022 May 15;36(5):609-613. doi: 10.7507/1002-1892.202202043.
To evaluate the effectiveness of membrane induction technique in the treatment of Gustilo-Anderson ⅢB type injury of distal femur complicated with bone defect.
The clinical data of 20 patients with Gustilo-Anderson ⅢB type injury of distal femur complicated with bone defects admitted between January 2019 and December 2020 were retrospectively analyzed, including 15 males and 5 females, with an average age of 35 years (range, 19-70 years). Causes of injuries included 15 cases of traffic accidents and 5 cases of falling from height. Bone defect located at metaphyseal in 11 cases and at proximal metaphyseal in 9 cases. The time from injury to primary first-stage surgery was 4-28 hours, with an average of 11 hours. After primary radical debridement, the length of bone defect was 3-12 cm, with an average of 6 cm. Antibiotic-containing bone cement was implanted in the bone defect site to induce membrane formation. At 34-56 days (mean, 45 days) after the first-stage surgery, bone grafting was performed in the induced membrane for the repair and reconstruction of bone defects; 16 patients received a combination of autogenous cancellous and allogeneic bone grafts and 4 patients received cancellous bone grafts. The bone graft healing time after the second-stage surgery was recorded; the visual analogue scale (VAS) score and Lysholm score were compared before the second-stage bone graft and at last follow-up to evaluate the pain and functional improvement of the affected limb; and the knee joint range of motion at last follow-up was recorded.
None of the patients had a second revision after the first-stage surgery, 1 patient recieved flap transfer and the flap survived well after operation. All patients were followed up 12-36 months after the second-stage surgery, with an average of 23 months. All patients achieved bone union, and the bone union time was 7-10 months (mean, 8.4 months). No bone nonunion or donor site related complications occurred. The Lysholm score and VAS score at last follow-up were 85.6±4.1 and 1.7±0.8, respectively, and they were significantly improved when compared with those before the second-stage bone defect repair (42.7±4.6 and 7.1±0.8, respectively) ( =37.410, <0.001; =21.962, <0.001). Knee flexion range of motion was 60°-120°, with an average of 95°; the limit of elongation was 0°-10°, with an average of 5°.
For Gustilo-Anderson ⅢB type injury of distal femur complicated with bone defect, induction membrane technique can effectively control infection, promote bone healing of the defect site, and effectively restore the function of lower limbs with satisfactory effectiveness.
评估膜诱导技术治疗股骨远端 Gustilo-Anderson ⅢB 型损伤并伴有骨缺损的有效性。
回顾性分析 2019 年 1 月至 2020 年 12 月收治的 20 例股骨远端 Gustilo-Anderson ⅢB 型损伤并伴有骨缺损患者的临床资料，其中男性 15 例，女性 5 例，平均年龄 35 岁（19 - 70 岁）。受伤原因包括交通事故 15 例，高处坠落 5 例。骨缺损位于干骺端 11 例，近端干骺端 9 例。受伤至一期初次手术时间为 4 - 28 小时，平均 11 小时。一期彻底清创后，骨缺损长度为 3 - 12 cm，平均 6 cm。在骨缺损部位植入含抗生素骨水泥诱导膜形成。一期手术后 34 - 56 天（平均 45 天），在诱导膜内行植骨修复重建骨缺损；16 例患者采用自体松质骨与异体骨联合移植，4 例患者采用松质骨移植。记录二期手术后骨移植愈合时间；比较二期骨移植前及末次随访时的视觉模拟评分（VAS）和 Lysholm 评分，评估患肢疼痛及功能改善情况；记录末次随访时膝关节活动范围。
一期手术后无患者进行二次翻修，1 例患者行皮瓣转移，术后皮瓣存活良好。所有患者二期手术后随访 12 - 36 个月，平均 23 个月。所有患者均达到骨愈合，骨愈合时间为 7 - 10 个月（平均 8.4 个月）。未发生骨不连或供区相关并发症。末次随访时 Lysholm 评分和 VAS 评分分别为 85.6±4.1 和 1.7±0.8，与二期骨缺损修复前（分别为 42.7±4.6 和 7.1±0.8）相比有显著改善（ =37.410，<0.001； =21.962，<... （此处原文似乎不完整）<0.001）。膝关节屈曲活动范围为 60° - 120°，平均 95°；伸直受限为 0° - 10°，平均 5°。
对于股骨远端 Gustilo-Anderson ⅢB 型损伤并伴有骨缺损，诱导膜技术能有效控制感染，促进缺损部位骨愈合，有效恢复下肢功能，疗效满意。
