膜诱导技术联合皮瓣移植治疗急性创伤性指骨缺损合并软组织缺损的临床应用

Clinical Application of Membrane Induction Technique Combined with Flap Transplantation in the Treatment of Acute Traumatic Phalangeal Bone Defects Combined with Soft Tissue Defects

摘要: 目的：探讨膜诱导技术联合皮瓣移植治疗急性创伤性指骨缺损合并软组织缺损的临床疗效、安全性及关键技术，为保指治疗提供实践依据。方法：2022年3月~2025年1月收治的25例急性创伤性指骨缺损合并软组织缺损的病例，采用膜诱导技术联合皮瓣移植治疗。该技术分两个阶段：第一阶段，彻底清创，植入载庆大霉素骨水泥，根据缺损部位、面积及血供条件选择个性化皮瓣修复创面；第二阶段，行骨水泥取出 + 植入自体髂骨。术后定期随访，评估伤口愈合、皮瓣成活、骨愈合时间、骨吸收及手功能评分情况。结果：25例患者获得随访，两阶段术后均无感染发生，皮瓣均成活，1例指动脉岛状皮瓣边缘局部坏死，第二阶段手术时进行清创后直接缝合。第二阶段术后随访时间为9~23月，平均14月，期间无骨感染、骨愈合率100%，骨愈合时间平均3.7个月。2例末节植骨出现轻度骨吸收(吸收量 < 20%)，未影响手指功能及稳定性，无需二次干预。2例取骨区发生脂肪液化，经换药后愈合。根据中华医学会手外科学会上肢部分功能评定试用标准评定疗效：优9例、良10例、可5例、差1例，优良率76%。结论：膜诱导技术联合个性化皮瓣移植治疗急性创伤性指骨缺损合并软组织缺损是安全有效的保指治疗方案；一期彻底清创、合理选择载抗生素骨水泥与皮瓣类型、二期精准植骨是提升疗效的关键。

Abstract: Objective: To investigate the clinical efficacy, safety, and key techniques of the membraneinduced technique combined with flap transplantation in the treatment of acute traumatic phalangeal bone defects with soft tissue defects, so as to provide a practical basis for finger preservation. Methods: Twenty-five patients with acute traumatic phalangeal defects and soft tissue defects treated between March 2022 and January 2025 were included. All patients underwent the membrane-induced technique combined with flap transplantation. The procedure was performed in two stages: In the first stage, thorough debridement was performed, followed by implantation of gentamicin-loaded bone cement. Individualized flaps were selected according to the defect location, area, and blood supply to repair the wound. In the second stage, the bone cement was removed and replaced with autologous iliac bone grafts. Postoperative follow-up was conducted regularly to assess wound healing, flap survival, bone healing time, bone resorption, and hand function scores. Results: All 25 patients were followed up. No infections occurred after either stage of surgery, and all flaps survived. One patient experienced partial marginal necrosis of a digital artery island flap, which was debrided and directly sutured during the second-stage surgery. The follow-up period after the second stage ranged from 9 to 23 months, with an average of 14 months. No bone infection occurred, and the bone healing rate was 100%, with an average healing time of 3.7 months. Mild bone resorption (resorption < 20%) occurred in two cases involving distal phalangeal bone grafting, which did not affect finger function or stability and required no further intervention. Two cases developed fat liquefaction at the bone graft harvesting site, which healed after dressing changes. According to the Trial Standard for Upper Limb Function Evaluation of the Chinese Society of Hand Surgery, the outcomes were rated as excellent in 9 cases, good in 10 cases, fair in 5 cases, and poor in 1 case, with an excellent-to-good rate of 76%. Conclusion: The membrane-induced technique combined with individualized flap transplantation is a safe and effective treatment for acute traumatic phalangeal defects with soft tissue defects, offering a reliable option for finger preservation. Key factors for success include thorough debridement in the first stage, appropriate selection of antibiotic-loaded bone cement and flap type, and precise bone grafting in the second stage.