摘要
目的探讨设计和应用随意髂骨皮瓣治疗尺、桡骨缺损性骨不连的效果。方法自1986年11月～2000年9月共收治尺、桡骨缺损性骨不连患者13例,男10例,女3例;年龄19～42岁,平均30岁。桡骨8例,尺骨5例。缺损性骨不连10例,萎缩性骨不连3例。根据尺、桡骨及皮肤缺损的范围,在同侧髂部沿髂嵴长轴的任意部位切取髂骨皮瓣;尺骨缺损取臀侧髂骨瓣,桡骨缺损取腹侧髂骨瓣。8例行腹侧髂骨皮瓣移位术;5例行臀侧髂骨皮瓣移位术。髂骨瓣平均为2.0cm×5.5cm,皮瓣面积平均为5.5cm×9.2cm。肢体功能参照Enneking系统进行评定。结果术后随访1.2～13.3年,平均3.5年,13例患者全部治愈,伤口一期愈合,皮瓣全部成活,髂骨瓣与骨缺损两端同期愈合,骨折临床愈合时间平均为3.3个月。肢体功能平均恢复81%。结论实验研究证明髂骨瓣血运丰富,骨细胞代谢正常,等同于轴型骨皮瓣的活骨移植。采用随意髂骨皮瓣修复尺、桡骨缺损具有手术简单、效果可靠、合并症少和易于推广的特点。
Objective To investigate the design of random iliac osteocutan eo us flap and its clinical effects in treatment of the defective non-union of isol ated forearm bone experimentally and clinically. Methods Four mongrels were used to undergo abdominal random iliac osteocutaneous flap on one side and free ilia c bone flap on the opposite side simultaneously. The iliac bone of flaps were re planted and fixed with two crossed Kirschner pins. The specimens were observed b y histological and tetracycline fluorescence examination. Clinically, there were 13 patients with posttraumatic non-unions in radius or ulna between November 19 86 and September 2000, including 10 males and 3 females aging from 19 to 42 year s. The lesions were located at radius in 8 and ulna in 5, 10 of which had infect ion history. Depending on the defective area of the radius or ulna and skin, ran dom iliac osteocutaneous flap was designed along with the long axis of the iliac crest in the same side of the affected limb. The pedicle of the flap was preser ved on the ventral or gluteal aspects to reconstruct the radius or ulna defect. In this study, ventral random iliac osteocutaneous flap was transposed in 8 case s, and gluteal random iliac osteocutaneous flap in 5 cases. The average size of iliac block graft was 2.0 cm×5.5 cm, the average area of the skin flap was 9.2 cm×5.5 cm. Results Experimentally, the osteocytes within iliac osteocutaneous f lap were alive showed by histological examination at 1, 2 and 3 weeks postoperat ively, whereas, the osteocytes within free iliac bone block were necrotic. The n ew bone formation in iliac osteocutaneous flap was more obvious than that of rep lanted free iliac bone. Thirteen patients were followed up from 1.2 to 13.3 year s after operation(average, 3.5 years). All the fractures were united, the wound s were primary healing, and the skin flaps were all survived, the iliac block gr aft were healed with the two ends of fracture simultaneously. The clinical avera ge time of bone union was 3.3 months. The recovery of the limb function was up t o 81% of the normal limb by Enneking system. Conclusion The experiment demonstra tes that the iliac block graft in composite osteocutaneous flap is of sufficient blood supply and survived osteocytes, which is equal to the living bone transpl antation of the axial osteocutaneous flap. The advantages of random iliac osteoc utaneous flap to repair forearm lesion are simple, reliable and less complicatio ns, so it can be popularized easily.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2003年第12期714-718,共5页
Chinese Journal of Orthopaedics
