Objective: To evaluate the effectiveness of membrane induction technique in the treatment of Gustilo-Anderson ⅢB type injury of distal femur complicated with bone defect.
Methods: 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.
Results: 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) ( t=37.410, P<0.001; t=21.962, P<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°.
Conclusion: 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.
目的: 评价膜诱导技术治疗合并骨缺损的股骨远端Gustilo-Anderson ⅢB型损伤的效果。.
方法: 回顾分析2019年1月—2020年12月收治的20例合并骨缺损的股骨远端Gustilo-Anderson ⅢB型损伤患者临床资料。男15例，女5例；年龄19～70岁，平均35岁。致伤原因：交通事故伤15例，高处坠落伤5例。骨缺损部位：干骺端11例，干骺端近端干部9例。受伤至一期手术时间为4～28 h，平均11 h。一期根治性清创术后骨缺损长度为3～12 cm、平均6 cm，于骨缺损部位植入含抗生素的骨水泥诱导生物膜产生；一期术后34～56 d（平均45 d）行二期手术，在形成的诱导膜中植骨修复骨缺损，16例患者采用自体松质骨和同种异体骨混合植骨，4例采用自体松质骨植骨。记录二期术后植骨愈合时间；比较二期植骨前及末次随访时疼痛视觉模拟评分（VAS）及Lysholm评分，评价患肢疼痛和功能改善情况；记录末次随访时膝关节活动度。.
结果: 所有患者一期术后均无再次翻修，1例行皮瓣转移覆盖术者术后皮瓣成活良好。二期术后所有患者均获随访，随访时间12～36个月，平均23个月。二期术后所有患者骨断端均达骨性愈合，愈合时间7～10个月，平均8.4个月。无骨不愈合及供区相关并发症发生。末次随访时Lysholm评分和VAS评分分别为（85.6±4.1）、（1.7±0.8）分，与二期植骨前 ［分别为（42.7±4.6）、（7.1±0.8）分］比较差异均有统计学意义（ t=37.410， P<0.001； t=21.962， P<0.001）。膝关节屈曲活动度60°～120°，平均95°；伸直受限0°～10°，平均5°。.
结论: 膜诱导技术治疗合并骨缺损的股骨远端Gustilo-Anderson ⅢB型损伤，可有效控制感染和修复局部骨缺损，恢复患者良好肢体功能，临床疗效确切。.
Keywords: Bone defect; Gustilo-Anderson ⅢB type injury; induction membrane technique; open fracture of the distal femur.