带血管蒂髂骨瓣移植修复下肢骨及其周围软组织缺损  

Vascularized pedicle iliac crest for the repair of bone and soft tissue defect of lower extremity

作　　者：吴克俭[1] 侯树勋[1] 张伟佳[1] 王富[1] 郭继东[1] 孙大铭[1] 郑小勇 

机构地区：[1]解放军第三○四医院骨科,北京100037

出　　处：《中华外科杂志》2005年第12期784-787,共4页Chinese Journal of Surgery

摘　　要：目的探讨带血管蒂髂骨瓣移植在修复下肢骨及其周围软组织缺损中的作用。方法针对小腿、足解剖结构和伤后骨与软组织易缺损的特点,利用游离髂骨移植必须携带周围肌肉,设计带血管蒂的髂骨肌肉瓣,移植修复下肢骨及软组织缺损;髂骨肌肉瓣血管与受区血管吻合后于骨瓣周围肌肉表面皮片覆盖。结果手术后1周,移植皮片全部植在髂骨周围的肌肉表面,皮片成活间接证明移植骨瓣成活;皮片全部成活4例,大部分成活3例;术后1个月均可见髂骨瓣与受区断端间有少量的骨痂形成,修复足跖骨4个月后拔除克氏针,胫骨6～8个月拆除外固定架,扶拐行走2～4个月;术后随访经6～15个月(平均10个月),双下肢等长,无溃疡,行走负重良好,外形及功能满意。结论单纯髂骨游离移植修复骨及软组织缺损一次完成手术操作,解剖塑形及外观比传统术式更满意,是修复小腿及足外伤软组织和骨缺损的较好术式。Objective To study the role of transplantation of the vascularized pedicle iliac crest for the repair of bone and soft tissue defect of lower extremity. Methods The vascularized pedicle iliac crest was designed for the repair of bone and soft tissue defect of lower extremity according to anatomic feature of leg and foot.Skin graft was used for coverage of the iliac flap. Results Skin survival could demonstrate the survival of the vascularized pedicle iliac crest indirectly one week postoperatively.Skin survived completely in 4 cases and partly in 3 cases.Callus was seen at the transplantation site one month postoperatively, and K-wires were removed 4 months later in the cases of metatarsal defect.The external fixators were removed in the cases of tibia defect 6 to 8 months postoperatively.The functions of lower extremities were restored in 2 to 4 months.The bone and soft tissue defects were repaired, and ultimate function and cosmetic effects were satisfied after the mean follow up of 10 months (ranged from 6 to 15 months). Conclusion Transplantation of the vascularized pedicle iliac crest is an ideal method for the repair of bone and soft tissue defect of lower extremity.The operation can be performed in one stage. The functions and cosmetic effects are better than the traditional methods.

关 键 词：周围软组织缺损 移植修复 下肢骨 带血管蒂髂骨瓣移植 游离髂骨移植 解剖结构 移植皮片 皮片成活 骨痂形成 外固定架 术后随访 下肢等长 手术操作 传统术式 肌肉瓣 吻合后 手术后 骨周围 明移植 克氏针 足跖骨 骨缺损 足外伤 

分 类 号：R687.3[医药卫生—骨科学]