带血管蒂双折叠腓骨移植治疗开放性股骨骨折伴大段骨缺损

目的 探讨大段骨缺损股骨骨折的修复方法及疗效。方法 自1999年6月～2005年2月对8例大段骨缺损股骨骨折，采用吻合血管的双折叠腓骨移植，结合适当内固定／外固定治疗。结果 术后随访13个月～5年8个月，平均3年2个月，移植骨生长良好，骨折愈合，能完全负重。结论 带血管蒂双折叠组合腓骨移植，结合适当内固定／外固定治疗伴大段骨缺损股骨骨折，愈合快，支撑力强，成功率高。     

带监测皮岛的组合腓骨移植治疗股骨大段缺损对骨强度及负重行走能力的作用

背景应用吻合血管的游离腓骨移植治疗长管骨大段骨缺损疗效可靠,尤其是带监测皮岛的腓骨移植疗效更可靠,然而单腓骨移植修复负重长管骨则有折断的可能.目的探讨带监测皮岛的组合腓骨移植治疗股骨大段缺损的临床疗效.设计自身前后对照观察.单位广州市第一人民医院骨科脊柱外科.对象选择1995-07/2003-11广州市第一人民医院骨科脊柱外科收治的股骨骨缺损患者14例.部位股骨下端5例,股骨中段9例,骨缺损长度6～28 cm.干预带监测皮岛腓骨折断成双腓骨移植7例,带监测皮岛腓骨捆绑同种异体骨7例.监测皮岛大小3 cm×5 cm,切取腓骨长度16～32 cm.同种异体干冻骨长度12～28 cm.术后监测手术伤口及监测皮岛情况.主要观察指标患者骨缺损处带监测皮岛双腓骨或捆绑同种异体骨复合移植皮瓣成活情况、移植骨形态变化及负重行走能力.结果14例患者均进入结果分析.双腓骨组7例随访3年,捆绑同种异体骨组7例随访1年.14例监测皮岛全部成活,捆绑同种异体骨组1例术后3个月有黄色渗液而取出异体骨,其余6例随访显示移植腓骨与异体骨紧密结合,移植骨增粗、塑造,与受区股骨口径相当.两组患者术后6个月弃拐负重行走,移植骨无折断.结论带监测皮岛双腓骨或捆绑同种异体骨移植修复股骨缺损,可增加移植腓骨骨量和强度,减少或避免移植腓骨折断.     

带监测皮岛的组合腓骨移植治疗股骨大段缺损对骨强度及负重行走能力的作用

背景：应用吻合血管的游离腓骨移植治疗长管骨大段骨缺损疗效可靠，尤其是带监测皮岛的腓骨移植疗效更可靠，然而单腓骨移植修复负重长管骨则有折断的可能。目的：探讨带监测皮岛的组合腓骨移植治疗股骨大段缺损的临床疗效。设计：自身前后对照观察。单位：广州市第一人民医院骨科脊柱外科。对象：选择1995-07／2003-11广州市第一人民医院骨科脊柱外科收治的股骨骨缺损患者14例。部位：股骨下端5例，股骨中段9例，骨缺损长度6-28cm。干预：带监测皮岛腓骨折断成双腓骨移植7饼，带监测皮岛腓骨捆绑同种异体骨7例。监测皮岛大小3cm&;#215;5cm，切取腓骨长度16～32cm。同种异体干冻骨长度12～28cm。术后监测手术伤口及监测皮岛情况。主要观察指标：患者骨缺损处带监测皮岛双腓骨或捆绑同种异体骨复合移植皮瓣成活情况、移植骨形态变化及负重行走能力。结果：14例患者均进入结果分析。双腓骨组7例随访3年，捆绑同种异体骨组7例随访1年。14例监测皮岛全部成活，捆绑同种异体骨组1例术后3个月有黄色渗液而取出异体骨，其余6例随访显示移植腓骨与异体骨紧密结合，移植骨增粗、塑造，与受区股骨口径相当。两组患者术后6个月弃拐负重行走，移植骨无折断。结论：带监测皮岛双腓骨或捆绑同种异体骨移植修复股骨缺损，可增加移植腓骨骨量和强度，减少或避免移植腓骨折断。     

吻合血管的双腓骨组合移植治疗下肢大段骨缺损的护理12例

自 1975年Taylor首先报道应用吻合血管的腓骨移植修复骨缺损获得成功以后 ,吻合血管的骨移植已成为临床修复长骨缺损的主要方法。对于下肢长骨 10cm以上的大段缺损 ,单根腓骨移植修复 ,其支撑作用较差 ,吻合血管的双腓骨组合移植修复比较理想。我院自 1989年以来收治 12例 ,围手术期的护理对手术的成功及术后的顺利康复起着重要的作用 ,现将护理体会报告如下。1　临床资料1.1　一般资料。本组 12例中 ,男 8例 ,女 4例 ,年龄 12～ 38岁 ,病程 2～ 6a。股骨缺损 9例 ,缺损长12～ 18cm ;胫骨缺损 3例 ,缺损长度分别为 17、15、14cm。病因 :慢…     

吻合血管的腓骨移植修复下肢骨缺损的疗效

目的探讨吻合血管的腓骨移植修复下肢骨缺损的临床疗效。方法对因创伤导致下肢长段骨缺损患者11例,延期采用带监测皮岛(瓣)的腓骨移植修复,皮岛(瓣)切取3 cm×5 cm~7 cm×11 cm,骨缺损6~20 cm,其中吻合血管的双侧腓骨组合移植1例,吻合血管的单根腓骨移植3例,吻合血管的折叠式腓骨移植7例,自体血管移植桥接3例,修复股骨3例,胫骨7例,胫骨远端并踝关节缺损1例。结果术后移植组织全部成活,皮瓣弹性及色泽良好。术后3~6个月患肢开始负重行走。术后随访6个月~2年,复查X线片示移植骨全部骨性愈合,恢复行走功能。结论采用带监测皮岛(瓣)的腓骨移植修复下肢骨缺损安全可靠,疗效好,疗程短,功能恢复满意。同时应根据患者的不同伤情及条件选择更适合于患者的本种术式,对功能的恢复尤为重要。     

吻合血管的双腓骨组合移植治疗下肢大段骨缺损的护理12例

自1975年 Taylor 首先报道应用吻合血管的腓骨移植修复骨缺损获得成功以后,吻合血管的骨移植已成为临床修复长骨缺损的主要方法。对于下肢长骨10cm 以上的大段缺损,单根腓骨移植修复,其支撑作用较差,吻合血管的双腓骨组合移植修复比较理想。我院自1989年以来收治12例,围手术期的护理对手术的成功及术后的顺利康复起着重要的作用,现将护理体会报告如下。     

携带监测皮岛组合腓骨移植修复四肢长段骨缺损手术护理

目的 探讨带血管腓骨组合同种异体骨移植修复长段骨缺损手术的护理方法和效果.方法 回顾总结1994年1月～2007年12月27例因创伤、骨肿瘤、先天性假关节形成致骨缺损病人施行带监测皮岛组合腓骨移植手术的治疗及护理.术后加强对携带皮岛颜色、温度、弹性、毛细血管充盈、伤口渗液、疼痛、全身状况等指标的监测记录,注意患肢体位、功能锻炼,结合影象学检查结果评估移植的组合腓骨愈合情况.结果 有1例术后2 d监测皮瓣显示静脉危象,2例牙龈出血和鼻出血,16例受骨区伤口在7～22 d(平均12 d)出现不同程度的无菌性渗液,其中1例取出部分异体骨,加强换药处理后愈合.随访10～108个月(平均43个月),x线显示复合腓骨与自体骨骨性愈合;监测皮岛与周围皮肤正常愈合.结论 带监测皮岛的组合腓骨移植是修复长段骨缺损的好方法.皮岛血循环能及时了解腓骨血供和早期预测长段复合骨的转归;注意伤口渗液的观察和处理,防治感染和加强重建肢体功能锻炼是手术成功的关键.     

携带监测皮岛组合腓骨移植修复四肢长段骨缺损手术护理

目的 探讨带血管腓骨组合同种异体骨移植修复长段骨缺损手术的护理方法和效果.方法 回顾总结1994年1月～2007年12月27例因创伤、骨肿瘤、先天性假关节形成致骨缺损病人施行带监测皮岛组合腓骨移植手术的治疗及护理.术后加强对携带皮岛颜色、温度、弹性、毛细血管充盈、伤口渗液、疼痛、全身状况等指标的监测记录,注意患肢体位、功能锻炼,结合影象学检查结果评估移植的组合腓骨愈合情况.结果 有1例术后2 d监测皮瓣显示静脉危象,2例牙龈出血和鼻出血,16例受骨区伤口在7～22 d(平均12 d)出现不同程度的无菌性渗液,其中1例取出部分异体骨,加强换药处理后愈合.随访10～108个月(平均43个月),x线显示复合腓骨与自体骨骨性愈合;监测皮岛与周围皮肤正常愈合.结论 带监测皮岛的组合腓骨移植是修复长段骨缺损的好方法.皮岛血循环能及时了解腓骨血供和早期预测长段复合骨的转归;注意伤口渗液的观察和处理,防治感染和加强重建肢体功能锻炼是手术成功的关键.     

携带监测皮岛组合腓骨移植修复四肢长段骨缺损手术护理

目的 探讨带血管腓骨组合同种异体骨移植修复长段骨缺损手术的护理方法和效果.方法 回顾总结1994年1月～2007年12月27例因创伤、骨肿瘤、先天性假关节形成致骨缺损病人施行带监测皮岛组合腓骨移植手术的治疗及护理.术后加强对携带皮岛颜色、温度、弹性、毛细血管充盈、伤口渗液、疼痛、全身状况等指标的监测记录,注意患肢体位、功能锻炼,结合影象学检查结果评估移植的组合腓骨愈合情况.结果 有1例术后2 d监测皮瓣显示静脉危象,2例牙龈出血和鼻出血,16例受骨区伤口在7～22 d(平均12 d)出现不同程度的无菌性渗液,其中1例取出部分异体骨,加强换药处理后愈合.随访10～108个月(平均43个月),x线显示复合腓骨与自体骨骨性愈合;监测皮岛与周围皮肤正常愈合.结论 带监测皮岛的组合腓骨移植是修复长段骨缺损的好方法.皮岛血循环能及时了解腓骨血供和早期预测长段复合骨的转归;注意伤口渗液的观察和处理,防治感染和加强重建肢体功能锻炼是手术成功的关键.     

异体骨及皮瓣移植修复小腿大段骨与皮肤缺损后的功能恢复效果

目的:报道应用异体骨和皮瓣移植及支架外固定治疗小腿骨和皮肤缺损的临床效果,并探讨异体骨移植出现的并发症及其处理方法。方法:选择1996-02/2003-02收治的小腿感染性大段骨缺损并皮肤缺损的患者39例,均为外伤造成小腿胫腓骨开放粉碎性骨折及包括皮肤在内的多种组织损伤。其中胫骨缺损长度为7～23cm,皮肤缺损面积为7cm×6cm～28cm×18cm。将患者分为一期修复组19例,先行扩创,再二期行异体骨及皮瓣移植;二期修复组20例,清创后一期行异体骨与皮瓣移植。两组均采用深低温冷冻异体胫骨及带骨膜皮瓣移植、可调式支架外固定,修复小腿感染性骨缺损并皮肤缺损。下肢功能评定参照Enneking系统。结果:39例患者平均随访2年7个月,全部进行结果分析。①患者肢体功能评价结果:一期修复组平均27.40分,肢体功能恢复91%。二期修复组平均28分,肢体功能恢复93%。两组患者术后6周可带外固定支架行走,术后6～8个月可拆支架行走。②移植皮瓣类型成活情况:两组患者共35例皮瓣成活,4例皮瓣远端部分坏死,经二次皮瓣修复,创面愈合。③异体骨与宿主骨干的愈合情况:术后X射线复查,移植的异体骨对位对线好,术后1月骨痂生长,6月后植入的异体骨骨性愈合。④主要并发症:一、二期修复组各2例皮瓣远端部分坏死、1例排斥反应,二期修复组1例外固定松动。结论:应用异体骨及带骨膜的复合皮瓣移植修复,取材方便,可加速骨的愈合,缩短疗程,恢复行走功能,是修复小腿感染性大段骨缺损并皮肤缺损的有效方法。     

Repair of articular cartilage defects in the patello-femoral joint with autologous bone marrow mesenchymal cell transplantation: three case reports involving nine defects in five knees

To investigate the effectiveness of autologous culture-expanded bone marrow mesenchymal cell transplantation for repairing articular cartilage defects, we transplanted autologous culture-expanded bone marrow mesenchymal cells into nine full-thickness articular cartilage defects of the patello-femoral joints (including two kissing lesions) in the knees of three patients, a 31 year-old female, a 44 year-old male and a 45 year-old male. Three weeks before transplantation, bone marrow blood was aspirated from the iliac crest. Adherent cells were cultured with media containing autologous serum. Single-passaged cells were collected, embedded in a collagen solution (5 x 10(6) cells/ml), placed on a collagen sheet, gelated, transplanted into the defect and covered with autologous periosteum or synovium. Six months after transplantation, the patients' clinical symptoms had improved and the improvements have been maintained over the follow-up periods (17-27 months). Histology of the first patient 12 months after the transplantation revealed that the defect had been repaired with the fibrocartilaginous tissue. Magnetic resonance imaging of the second patient 1 year after transplantation revealed complete coverage of the defect, but we were unable to determine whether or not the material that covered the defects was hyaline cartilage. Autologous bone marrow mesenchymal cells transplantation may be an effective approach to promote the repair of articular cartilage defects.     

Evaluation of the survivability of femoral shaft reconstructions after resection of tumor and tumor-like lesions

Background. The reconstruction of femoral shaft defects after tumor resection involves joining healthy bone fragments with plates or intramedullary rods, using methyl metacrylate cement or bone grafts. Material and methods. 50 patients (35 females and 15 males) were operated over the last 24 years. The patients' ages ranged from 12 to 80 years (mean 56). Results. There were 37 bone metastases, 11 primary neoplasms, 1 eosiniphilic granuloma and 1 solitary bone cyst. Plates were used for reconstruction in 17 cases, and intramedullary rods in 31 cases. Long intramedullary fibula grafts were used to stabilize bone fragments in 2 patients with benign lesions. The post-resection defect was filled with methyl metacrylate cement in 47 cases, and with bone chips in 3 cases. One patient died shortly after surgery, 5 were nonambulatory because of diffusion of neoplastic changes. There were 4 deep infections and 4 tumor recurrences in other patients. Mechanical failures occurred in 10 patients from 2 to 30 months postoperatively because of methyl metacrylate loosening. Conclusions. Bone-cement union is the decisive factor in stabilizing fragments after a tumor has been resected from the femoral shaft and the defect filled with cement. The defect filling after resection of a segment of the femur is only stable for a short time; later, there is loosening and the resultant fracture of the rod. Bone cement should be used to fill the defect in patients treated for metastases to bone, but not in patients with a primary bone tumor. Plates should not be used to join the fragment of the femur.     

腓骨带肌蒂转移加植骨治疗同侧胫骨骨髓炎骨缺损

目的 探讨腓骨带肌蒂转移治疗腰骨骨髓炎遗留缺损的疗效。方法根据胫骨缺损的长度，切取同侧腓骨带肌蒂转移至胫骨缺损区，植入大量松质骨，加内固定，置管冲洗。结果 手术治疗23例，经2-4年观察，骨愈合时间接近正常，而踝关节功能无明显障碍。结论 同侧腓骨作为转移材料，治疗慢性骨髓炎遗留胫骨缺损是简单、有效的供体，值得推广。     

腓骨肌皮瓣修复口腔下颌骨复合缺损的护理

[目的]探讨腓骨肌皮瓣修复口腔下颌骨复合缺损的观察和护理方法.[方法]对12例采用腓骨肌皮瓣修复口腔癌瘤术后下颌骨复合缺损的病人进行心理护理.严格术前准备,术后采取合适的体位,严密观察皮瓣移植的情况以尽早发现血管危象,进行呼吸道、口腔及饮食护理.[结果]12例腓骨肌皮瓣全部存活,病人获得满意的外观和功能.[结论]对采用腓骨肌皮瓣修复口腔癌瘤缺损的病人采取有效的观察和护理.是保证手术成功和病人康复的重要措施之一.     

颧骨牵张成骨与游离腓骨复合瓣联合移植修复上颌骨大型缺损:一种新方法探讨

背景:上颌骨是面中部形态和功能基石,但由于结构复杂,上颌骨大型缺损的功能性修复极具挑战性。目的:建立一种颧骨牵张成骨和游离腓骨复合瓣联合移植修复上颌骨大型缺损新方法。设计:病例观察。单位:解放军二五二医院口腔科。对象:选择于2005-12在河北省保定市解放军二五二医院收治的1例上颌肌上皮瘤需要手术的患者,男,42岁,该患者2年前曾因上颌骨肿物于本医院接受肿物及双侧上颌骨次全切除术,病理诊断为肌上皮瘤,1年后,肿物复发并占据全部右上颌。为彻底切除肿瘤需行右侧上颌骨全切术。作者为该患者设计了双侧颧骨牵张成骨及后期游离腓骨瓣移植联合修复上颌骨缺损的治疗方案,患者对手术方案知情同意。方法:对患者行双侧颧骨内置弧形牵张成骨术及游离腓骨复合瓣移植。手术分两个阶段,第Ⅰ阶段:右上颌骨全切后行双侧颧骨牵张成骨术:首先,于双侧上颌骨缺损腔外侧剩余颧骨上以摆动锯及骨凿截骨制备长约10mm骨转移盘并以多枚钛钉可靠固定颧骨内置弧形骨牵张器,为防止骨牵张器暴露于与口腔相通的缺损腔中,右侧以带蒂颊脂垫覆盖骨牵张器底面。左侧因上次行上颌骨次全切术时已行植皮术,成活良好,无需特殊处理。常规冲洗后,除加力端由颞部软组织穿出外,全层缝合关闭伤口。术后延迟1周后以0.2mm/次,2次/d的速度行骨牵引,其中右侧共牵引21d,左侧共牵引16d。固定8个月。第Ⅱ阶段:沿面部原韦伯氏切口切开,暴露并卸下骨牵张器,见骨牵张区新骨生成良好,骨性支持在上颌骨底位建立,按照hidalgo和Peng的方法制备游离腓骨复合瓣,并于下颌骨内侧制作隧道,借助模板对腓骨进行塑形成上颌牙弓形态,然后将其置入上颌牙槽嵴位置,以钛板将腓骨瓣固定于双侧牵引至上颌骨低位的颧骨上,血管蒂经下颌内侧隧道入颈部,常规行血管吻合。通过此项手术,上颌骨缺损为腓骨长肌充填,上颌牙槽嵴由腓骨修复。术后以大体观察及全口曲面断层片观察牵张器和腓骨瓣状况以及成骨和重建质量。主要观察指标:大体观察和全口曲面断层片考察骨牵张器及腓骨瓣状况以及成骨、重建效果。结果:治疗过程中,牵张器状况良好和腓骨瓣顺利成活。通过颧骨牵张成骨,骨组织支持在上颌骨低位建立,面中部外形恢复,缺损腔缩小;通过腓骨复合瓣移植,缺损腔修复,上颌牙槽嵴重建,口鼻腔分离,上唇突度恢复。在2项技术联合修复下,患者面型恢复良好。结论:颧骨牵张成骨和游离腓骨复合瓣可联合应用修复上颌骨大型缺损。一种上颌骨大型缺损修复新方法成功建立。     

Circulating red cells usually remain of host origin after bone marrow transplantation for severe combined immunodeficiency

Background: Patients with severe combined immunodeficiency (SCID) treated with allogeneic bone marrow transplantation often receive a milder conditioning regimen than patients who undergo transplantation for hematologic malignancy, and they regularly retain circulating white cells of host origin. The origin of circulating red cells following successful bone marrow transplantation to treat SCID is not known. Study Design and Methods: Review of the medical records identified all patients with SCID who underwent ABO-mismatched bone marrow transplantation at the University of California, San Francisco, between 1982 and 1994. The ABO and Rh phenotype at>6 months after transplantation was determined for all successful transplants by review of the medical record or the taking of a fresh blood sample for analysis. Patient-conditioning and donor bone marrow-preparative regimens were reviewed to assess their possible influence on the red cell phenotype after successful bone marrow transplantation. Results: Nine of 35 SCID patients who underwent successful transplantation received marrow from ABO-mismatched donors. Eight of the nine patients had only host red cells circulating at 6 to 84 months after transplantation, while one patient had only donor red cells circulating at 48 months after transplantation. None of the patients had circulating red cells of both host and donor origin. Conditioning regimens included cyclophosphamide and antithymocyte globulin for all nine patients; only three patients also received total body irradiation. Seven of the nine patients received related-donor, HLA- mismatched bone marrow, and two patients received HLA-identical bone marrow; eight patients received T-cell-depleted bone marrow. The one patient whose red cell phenotype converted to that of the donor received T-cell-depleted, haploidentical marrow, and the preparative regimen included chemotherapy and total body irradiation. Conclusion: SCID patients successfully treated with allogeneic bone marrow transplantation typically fail to show circulating red cells of donor phenotype; this finding is in contrast to the universal presence of circulating donor red cells following successful bone marrow transplantation to treat hematologic malignancies and other diseases. The milder conditioning regimens typically given to patients with SCID, along with T-cell depletion and HLA mismatching, may play a role in this different outcome. It is not known whether the inability to find circulating red cells of donor origin is due to a failure to engraft donor pluripotent stem cells or a failure of engrafted donor stem cells to differentiate along the erythroid lineage.