CAJ | 학술논문

目的通过研究血管化及促进骨愈合的方法,解决大段异体骨移植骨吸收、骨不连及再骨折等并发症.方法对四肢10 cm以上长段骨缺损21例,采用钢板、外固定架等常规方法将大段异体骨与自体骨固定,同时采用异体骨与自体血管束、带血供骨或骨膜组合的方法,使异体骨血管化,达到促进骨愈合、防止异体骨溶解、吸收等并发症作用.其中4例采用局部血管束植入一侧断端;4例采用带血管髂骨块嵌入长段骨中部;2例带血管髂骨植入一侧骨断端;2例带血管腓骨嵌入中部;6例带血管骨膜植入一侧断端;另外血管束或骨膜加骨块组合植入3例.结果 21例中经一次治疗骨性愈合14例,经二次手术痊愈6例,失败1例.出现骨吸收、不愈合及再骨折等并发症7例,合并感染4例.经随访功能、外观满意.结论采用自体带血管骨(膜)与同种异体骨组合移植治疗长段骨缺损,可改善大段异体骨移植的骨吸收、骨不连等并发症,有利于骨折的早期愈合.为治疗长段骨缺损较为理想的方法.
목적 통과연구혈관화급촉진골유합적방법,해결대단이체골이식골흡수、골불련급재골절등병발증.방법 대사지10 cm이상장단골결손21례,채용강판、외고정가등상규방법장대단이체골여자체골고정,동시채용이체골여자체혈관속、대혈공골혹골막조합적방법,사이체골혈관화,체도촉진골유합、방지이체골용해、흡수등병발증작용.기중4례채용국부혈관속식입일측단단;4례채용대혈관가골괴감입장단골중부;2례대혈관가골식입일측골단단;2례대혈관비골감입중부;6례대혈관골막식입일측단단;령외혈관속혹골막가골괴조합식입3례.결과 21례중경일차치료골성유합14례,경이차수술전유6례,실패1례.출현골흡수、불유합급재골절등병발증7례,합병감염4례.경수방공능、외관만의.결론 채용자체대혈관골(막)여동충이체골조합이식치료장단골결손,가개선대단이체골이식적골흡수、골불련등병발증,유리우골절적조기유합.위치료장단골결손교위이상적방법.
Objective To study the method of solving the complications of large allograft including resorption, nonunion and refracture by means of vascularization and the way of improving bone healing. Methods The bone defect longer than 10 cm of limbs were found in 21 cases, plate or external fixator were used to fix allograft bone, and then vascularied autologous bone or periosteum were transplanted or inserted to the massive allograft In order to vascularizate allograft, improve bone healing and prevent complications of bone resorption and osteolysis. 4 cases were implanted by local vascular bondle in one end. 4 cases were transplanted vascular iliac bone into middle part the allograft bone, 2 cases were into one end. 2 cases were transplanted by vascular fibular bone. 6 cases were used vascular periosteum. 3 cases were used combined methods. Results Twenty-one cases with 10 cm or more bone defect in this group were treated by the method above. 14 cases were achieved primary healing, 6 were healing by farther operation, 1 failure. Complications were found in 7 cases, 4 occur infection in all. All were achieved satisfactory function and outlook by follow-up. Conclusion The method of vascularied autologous bone or periosteum combined with massive allograft are effective to improve bone union, reduce the complication of bone resorption and osteolysis,which proved usefull to treat large bone defect.