【摘要】 目的探讨采用VSD联合诱导膜技术治疗创伤性骨缺损的临床疗效。方法 2013年1月—2018年9月广州中医药大学第一附属医院创伤骨科收治的创伤性骨缺损患者12例,男性8例,女性4例;年龄19～62岁,平均41.3岁;4例为股骨骨缺损,8例为胫骨骨缺损。清创后,软组织缺损范围为2cm×3cm～17cm×8cm,软组织修复疗程为3～16周,平均9.3周。患者Ⅰ期均采用VSD联合诱导膜技术修复损伤的软组织,Ⅱ期予诱导膜技术治疗创伤后骨缺损。术后评估皮瓣成活、创面和骨缺损的愈合、并发症的发生、邻近关节的功能恢复情况。结果随访14～32个月平均18.6个月,末次随访,12例患者术后创面均实现愈合。其中,4例在Ⅰ期VSD术后直接行创面缝合,8例在Ⅰ期VSD术后创面仍有感染、愈合不良,经多次清创及VSD术治疗,感染控制后,8例患者中2例行创面直接缝合,另6例行皮瓣移植,其中1例行皮瓣移植后,皮瓣边缘出现坏死,经反复清创和VSD术治疗后,皮瓣成活良好。骨缺损区植骨后,11例生长良好,1例出现骨质吸收,经再次清创植骨后,实现愈合。依据按照Karistrom和Olemd膝、踝关节功能评定标准,本组病例优3例,良7例,中2例,优良率为83.3%(10/12)。结论采用VSD联合诱导膜技术治疗创伤性骨缺损,手术操作简单,创面愈合较好,皮瓣成活率高,骨缺损修复良好,可以促进患肢关节功能的恢复。更多还原

【Abstract】 Objective To investigate the clinical efficacy of vacuum sealing drainage(VSD) combined with induced membrane technique in the treatment of traumatic bone defects. Methods The clinical data of 12 patients with traumatic bone defects admitted to the Department of Trauma and Orthopaedics,the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from Jan. 2013 to Sep. 2018 were retrospectively analyzed. There were 8 males and 4 females; the age ranged from 19 to 62 years,with an average of 41.3 years; 4 cases had femoral bone defects and 8 cases had tibial bone defects. After debridement,the soft tissue defect ranged from 2 cm×3 cm to 17 cm×8 cm,and the soft tissue repair course was 3 to 16 weeks,with an average of 9.3 weeks. In all patients,VSD combined with induction membrane technique was used to repair damaged soft tissue,and in the second phase,induced membrane technique was used to treat post-traumatic bone defect. The survival of the flap,the healing of the wound and bone defect,the occurrence of complications,and the recovery of the function of the adjacent joints were evaluated postoperatively. Results The follow-up period was 14 to 32 months, with an arerage of 18.6 months. At the last follow-up,12 patients recovered after operation. Among them,4 cases were directly sutured after VSD,8 cases of wounds were still infected after the first stage of VSD treatment. After repeated debridement and VSD treatment and infection control,2 cases of these 8 patients were wounded. The sutures were directly sutured,and the other 6 patients underwent flap transplantation. One of them had necrosis at the edge of the flap after flap transplantation. After repeated debridement and VSD treatment,the flap survived well. After bone grafting in the bone defect area,11 cases grew well. In 1 case,after bone grafting,bone resorption occurred,and healing was achieved after debridement and bone grafting again. According to Karistrom and Olemd knee and ankle joint function evaluation criteria,the result was excellent in 3 cases,good in 7 cases,and fair in 2 cases,and the excellent and good rate was 83.3%(10/12). Conclusion VSD combined with induced membrane technique for the treatment of traumatic bone defects is simple,with good wound healing,high flap survival rate and good bone defect repair,and can promote the recovery of adjacent joint function.更多还原