杨燎北+叶斌+周敏+魏碧霞+潘永良+陈建球

【摘要】 目的 研究探讨人工骨一期植骨治疗开放性掌骨损伤的临床效果。方法 59例开放性掌骨损伤患者， 其中19例采用内固定联合一期自体骨移植治疗记为自体组， 18例采用内固定联合一期异体骨移植治疗记为异体组， 22例采用内固定联合人工骨一期植骨治疗记为人工组。三组手术时均行彻底清创， 若患者皮肤软组织损伤需行邻位皮瓣移植恢复治疗。术后对三组患者进行随访， 并记录统计患者恢复情况与临床满意率。结果 三组患者皮瓣移植均一期存活 ， 创面愈合， 术后随访7～20个月， 自体组、异体组、人工组平均随访时长分别为（11.86±2.17）、（12.41±2.19）、（10.96±2.09）个月；术后患者骨缺损处均痊愈， 痊愈时长2～3个月 ， 自体组、异体组、人工组平均痊愈时长分别为（2.06±0.21）、（2.35±0.17）、（1.99±0.21）个月。三组上述时长比较差异无统计学意义（P>0.05）。自体组出现取骨手术相关并发症1例，异体组出现免疫排斥反应1例，经对症处理后均好转， 无后遗症。自体组对此次手术治疗临床满意率为 95%， 异体组为 67%， 人工组为95%。自体组、人工组临床满意率高于异体组， 差异具有统计学意义（P<0.05）。结论 采用内固定联合人工骨一期植骨能有效治疗开放性掌骨损伤， 病程缩短， 并发症发生几率降低， 减少伤痛给患者带来的痛苦， 手术时行彻底清创及邻位皮瓣移植恢复治疗能有效减少患者伤口感染， 是手术成功的关键之一。

【关键词】 开放性掌骨损伤；人工骨；临床效果

DOI：10.14163/j.cnki.11-5547/r.2016.18.009

【Abstract】 Objective To research and investigate clinical effect by artificial bone primary graft of bone in the treatment of open metacarpal bone injury. Methods Among 59 patients with open metacarpal bone injury， 19 cases as autologous group received internal fixation combined with autologous bone primary graft， 18 cases as allogeneic group received internal fixation combined with allogeneic bone primary graft， and 22 cases as artificial group received internal fixation combined with artificial bone primary graft. All groups received radical debridement， as well as necessary skin flap transplantation. Postoperative follow-up was taken to record rehabilitation and clinical satisfaction rate. Results Skin flap transplantation for all three groups showed primary survival and healed wound. Follow-up was made in three groups for 7～20 months， with mean follow-up time respectively as （11.86±2.17）， （12.41±2.19） and （10.96±2.09） months in autologous group， allogeneic group and artificial group. All patients had healed bone defect after operation， with healing time as 2～3 months. Mean healing times in autologous group， allogeneic group and artificial group were respectively （2.06±0.21）， （2.35±0.17） and （1.99±0.21） months. There was no statistically significant difference across the three groups （P>0.05）. Autologous group had 1 case with graft surgery-related complication， and allogeneic group had 1 case with immunological rejection. Both cases were cured after symptomatic therapy without sequela. Clinical satisfaction rates was 95% in autologous group， and that was 67% in allogeneic group and 95% in artificial group. Autologous group and allogeneic group had higher clinical satisfaction rate than allogeneic group， and the difference had statistical significance （P<0.05）. Conclusion Combination of internal fixation and artificial bone primary graft can effective treat open metacarpal bone injury， along with shortened course， reduced incidence of complications， and relieved pain in patients. As one of keys to successful operation， radical debridement and skin flap transplantation can effective reduce wound infection.

【Key words】 Open metacarpal bone injury； Artificial bone； Clinical effect

随着社会工业化、机械化发展， 各种创伤原因导致掌骨开放性损伤发生几率逐年增加[1]。其伤口恢复时间长， 断端及皮肤软组织污染， 极易导致骨不连、骨髓炎、骨坏死、骨折不愈等并发症的发生。因此需在手术早期进行充分术前准备如行彻底清创， 邻位皮瓣移植及稳定骨折等治疗， 合理制订治疗方案能有效减少治疗时间， 降低并发症发生几率， 缩短患肢功能恢复时间[2]。有……