四肢长骨骨缺损的临床分型及意义The clinical classification and significance of limb long bone defects
臧谋圣;王成琪;
摘要(Abstract):
[目的]通过文献回顾及临床实践总结提出四肢长骨骨缺损的临床分型,为临床治疗四肢长骨骨缺损提供一定的理论参考。[方法]以"长骨骨缺损""长骨骨缺损分型""骨移植""骨膜移植"为关键词检索Pub Med及国内影响因子较高的杂志数据库。共检索406篇,根据纳入标准选用37篇,结合临床实践进行分析总结。[结果]资料显示长骨骨缺损的定义模糊,分型也大体缺如。本文根据文献及临床实践将四肢长骨骨缺损四度十分法分型:即Ⅰ度(ⅠA、ⅠB、ⅠC)、Ⅱ度(ⅡA、ⅡB、ⅡC)、Ⅲ度(ⅢA、ⅢB、ⅢC)、Ⅳ度。[结论]四肢长骨骨缺损的四度十分法分型使四肢骨缺损诊断更加规范,对临床治疗有着一定的指导作用。
关键词(KeyWords): 长骨骨缺损;长骨骨缺损定义与分型;长骨骨缺损显微技术修复
基金项目(Foundation):
作者(Author): 臧谋圣;王成琪;
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DOI:
参考文献(References):
- [1]田晓华,赵敏,闫红旗,等.回收扩髓留取装置的研制与临床应用初步报告[J].中国矫形外科杂志,2010,22:1915-1917.
- [2]Deng ZS,Zhang X,Zou DQ,et al.Senior effect of drynariar hizome for human bonemarrow mesenchy-real stem cells[J].Chin J Modern Med,2005,16:2426-2429.
- [3]张大伟,田清业,刘先军,等.骨膜瓣复合开窗异体骨移植修复大段骨缺损[J].骨科,2012,2:72-76.
- [4]Meinig RP.Clinical use of resorbable polymeric membranes in the treatment of bone defects[J].Orthop Clin North Am,2010,1:39-47.
- [5]Zhao M,Zhou J,Li X,et al.Repair of bone defect with vascularized tissue engineered bone graft seeded with mesenchymal stem cells in rabbits[J].Microsurgery,2011,2:130-137.
- [6]Kong Z,Tian D,Yu H,et al.Treatment of traumatic bone defect with graft material of allogenic cancellous combined with autologous red marrow[J].Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi,2008,10:1251-1254.
- [7]Nishida J,Shimamura T.Management of reconstruction for bone defect after tumor excision:a review of alternatives[J].Med Sci Monit,2008,8:107-113.
- [8]林永新,吕振京,孙国栋,等.带血管蒂腓骨移植加锁定钢板治疗肱骨术后大段骨缺损的临床分析[J].中华显微外科杂志,2013,36:374-375.
- [9]Mankin IL,Springfield DS,Gebhardt MC,et al.Current status of allografting for bone tumors[J].Orthopedics,1992,10:1 147-1154.
- [10]Ortiz-Cruz E,Gebhardt MC,Jennings LC,et al.The results of transplantation of intercalary allografts after resection of tumors[J].J Bone Joint Surg Am,1997,1:97-106.
- [11]Moore JR,Weiland AJ,Daniel RK.Use of free vaseularized bone grafts in the treatment of bone tumors[J].Clin Orthop,1983,175:37-44.
- [12]Croce F,Risorto M,Coviello M,et al.Vascularised fibula trailsplant:technique,early results,indications and limitations[J].J Orthop Traumatol,1986,4:447-454.
- [13]Taylor GI,Miller GD,Ham FJ.The free vaseularized bone graft:a clinical extension of microvascular techniques[J].Plast Reconstr Surg,1975,5:533-544.
- [14]Salkeld SL,Patron LP,Barrack RL,et al.The effect of osteogenic protein-1 on the healing of segmental bone defects treated with autograft or allograft bone[J].J Bone Joint Surg Am,2001,83:803-816.
- [15]Van der Donk S,Weernieir T,Buma P,et a I.Rinsing morselized allognlfts improves bone and tissue ingrowth[J].Clin Orthop,2003,408:302-310.
- [16]O’Brien BM,Gundey GJ,Dooley BJ,et al.Folded free vascularized fibula transfer[J].Plast Reconstr Surg,1988,2:311-318.
- [17]El-Gammal TA,El-Sayed A,Kotb MM.Mierosurgical reconstruction of lower limb bone defects following tumor resection using vaseularized fibul osteoseptocutaneous flap[J].Microsurgery,2002,5:193-198.
- [18]Zaretski A,Amir A,Meller I,et al.Free fibula long bone reconstruetion in orthopedic oneology:a surgical algorithm for reconstruetive options[J].Plast Reconstr Surg,2004,7:1989-2000.
- [19]滕云升,智丰,刘重,等.游离腓骨(皮)瓣移植修复上肢长段骨缺损[J].中华手外科杂志,2011,27:348-350.
- [20]龚志鑫,张英泽,邵新中,等.应用带双皮岛的串式腓骨瓣游离移植修复前臂尺桡骨及皮肤联合缺损[J].中华显微外科杂志,2011,34:25-28.
- [21]范启申,周祥吉,郭德亮,等.小腿骨与皮肤复合缺损感染性创面治疗方法探讨[J].中华显微外科杂志,2003,1:19-21.
- [22]王剑利,王五洲,郭永强,等.长段同种异体骨与自体带血管组织组合治疗大段骨缺损的总结[J].中华显微外科杂志,2010,33:371-374.
- [23]任志勇,张维彬,王辉,等.皮瓣移植结合改良骨牵张治疗感染性小腿复合组织缺损[J].中华显微外科杂志,2010,33:487-488.
- [24]邹林,蔡锦方,刘立峰,等.小腿外侧腓骨皮瓣交腿修复合并血管损伤的大段胫骨骨感染及缺损[J].中华骨科杂志,2012,32:675-680.
- [25]沙漠,丁真奇,康两期,等.改良异体骨复合人工关节技术治疗股骨远端肿瘤性骨缺损[J].中华外科杂志,2012,50:569-571.
- [26]王臻,黄耀添,胡蕴玉,等.人工关节假体复合大段同种异体骨移植重建肢体功能[J].中华外科杂志,1999,37:727.
- [27]Donati D,Colangeli M,Colangeli S,et al.Allograft-prosthetic composite in the proximal tibia after bone tumor resection[J].Clin Orthop,2008,466:459-465.
- [28]Abudu A,Carter SR,Grimer RJ.The outcome and functional results of diaphyseal endoprostheses after tumour excision[J].J Bone Joint Surg Br,1996,4:652-657.
- [29]钟俊青,胡永成.节段型人工假体置换重建骨干肿瘤切除后缺损的初步报告[J].中华骨科杂志,2012,32:378-380.
- [30]李靖,王臻,郭征,等.带血管腓骨复合异体骨修复长骨肿瘤切除后骨缺损[J].中华骨科杂志,2011,31:605-610.
- [31]杨运发,张光明,徐中和,等.吻合血管腓骨与异体骨复合移植修复四肢长段骨缺损[J].中国修复重建外科杂志,2005,19:986-988.
- [32]张世民,唐茂林,穆广态,等.穿支皮瓣及相关术语的专家共识[J].中国临床解剖学杂志,2010,5:475-477.
- [33]黄雷,王剑,杨胜松,等.单边外固定架骨段滑移术治疗部分骨缺损[J].中华骨科杂志,2012,32:235-239.
- [34]林在俊,朱振安.骨延长术治疗下肢骨缺损与骨不连[J].国外医学·骨科学分册,2004,25:218-220.
- [35]丛海波,隋海明,王晨霖,等.骨搬运治疗四肢大段骨缺损的临床研究[J].中华骨科杂志,2008,28:567-570.
- [36]Sale M.The management of acute bone loss following trauma[M]//De Bastiani G,Apley AG,Goldberg A,eds.Orthofix external fixation in trauma and orthopaedics.2nd ed.Britain:Spriner Verlag,2001:355-369.