| 李延炜,林金河,薜超,等.半开放植骨术治疗感染性骨缺损合并软组织缺损的临床疗效.骨科,2025,16(4): 325-330. |
| 半开放植骨术治疗感染性骨缺损合并软组织缺损的临床疗效 |
| Clinical efficacy of semi-open bone grafting for treatment of osteomyelitis combined with soft tissue defect |
| 投稿时间：2025-03-11 |
| DOI：DOI：10.3969/j.issn.1674-8573.2025.04.007 |
| 中文关键词: 半开放植骨术 骨髓炎 骨感染 骨缺损 骨水泥 |
| 英文关键词: Semi-open bone grafting Osteomyelitis Bone infection Bone defect Bone cement |
| 基金项目:福建省自然科学基金（2023J011838） |
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| 中文摘要: |
| 目的 探讨半开放植骨术治疗四肢感染性骨缺损合并软组织缺损的疗效。方法 回顾性分析2020年3月至2023年4月我院采用半开放植骨术治疗的8例四肢感染性骨缺损合并软组织缺损病人的临床资料，其中男5例，女3例，年龄为（41.3±2.6）岁（14~68岁）；清创后骨缺损长度为（4.1±0.8） cm（2~13 cm），骨缺损体积为（24.3±2.2） cm3（12~54 cm3），软组织缺损面积为1.8 cm×0.7 cm~11 cm×6.5 cm。所有病例均由同一组术者进行骨清创，取自体髂骨松质骨填充骨缺损区，植骨区表面骨水泥片封闭覆盖，待植骨区表面肉芽覆盖后行植皮术等修复皮肤缺损。随访记录术后植骨区表面软组织充分覆盖时间、骨及软组织愈合时间、并发症等。结果 所有病人均获得随访，随访时间为（21.4±6.2）个月（10~47个月）。植骨区软组织膜层面充分覆盖时间为术后（7.4±2.1）周（2~16周），软组织愈合时间为（8.3±2.4）周（3~18周），骨愈合时间为（5.3±1.6）月（4~10月）。1例发生髂前上棘供区血肿积聚，通过部分拆线引流后治愈；1例植骨区表层骨缺血坏死，予浅层死骨清除，打通髓腔，延长骨水泥覆盖后治愈。结论 半开放植骨术可简便易行地处理复杂感染性骨缺损合并软组织缺损，对于符合适应证的病例是一种安全有效的选择。 |
| 英文摘要: |
| Objective To investigate the efficacy of modified semi-open bone grafting in the treatment of osteomyelitis defect combined with soft tissue defect in limbs. Methods The data of 8 patients with infective bone defects combined with soft tissue defect in limbs who underwent semi-open bone grafting from March 2020 to April 2023 in our hospital were retrospectively analyzed, including 5 males and 3 females, aged (41.3±2.6) years (14-68 years). The length of the bone defect after debridement was (4.1±0.8) cm (2-13 cm), the volume of the bone defect was (24.3±2.2) cm3 (12-54 cm3), and the area of the soft tissue defect was 1.8 cm× (0.7-11) cm × 6.5 cm. Bone debridement was performed in all cases by the same group of surgeons. The bone defect area was filled with cancellous bone of the iliac bone, and the surface of the bone graft area was closed and covered with bone cement pieces. After the surface of the bone graft area was covered with granulation, skin grafting was performed to repair the skin defect. The time of full coverage of soft tissue on the surface of bone graft area, the healing time of bone and soft tissue, and complications were recorded during the follow-up period. Results All patients were followed up for a period of (21.4±6.2) months (10-47 months). The sufficient coverage time of the soft tissue membrane layer in the bone grafting area was (7.4±2.1) weeks (2-16 weeks) after surgery, the soft tissue healing time was (8.3±2.4) weeks (3-18 weeks), and the bone healing time was (5.3±1.6) months (4-10 months). Hematoma accumulation at the donor site of anterior superior iliac spine occurred in 1 case, which was cured by partial suture removal and drainage. There was one case of bone graft area ischemic necrosis, which was cured after removal of superficial sequestrum, opening of the medullary cavity, and extension of bone cement coverage. Conclusion Semi-open bone grafting is a simple and feasible method for treating complex infectious bone defects combined with soft tissue defects, and is a safe and effective choice for cases that meet the indications. |
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