带血管腓骨移植的远期疗效报告  

Long- term results of vascularized fibular graft

作　　者：刘亚平[1] 程国良[1] 潘达德[1] 杨志贤[1] 方光荣[1] 曲智勇[1] 林彬[1] 汤海萍[1] 杜泽新 

机构地区：[1]解放军第四0一医院全军显微外科中心,青岛266071

出　　处：《中华骨科杂志》2001年第1期22-26,共5页Chinese Journal of Orthopaedics

摘　　要：目的分析带血管腓骨移植修复四肢长骨缺损的远期效果。方法对 19例应用带血管腓骨移植修复不同部位骨缺损患者进行 5～ 20年 (平均 10.79年 )远期随访，参照 Enneking系统对患肢功能进行评价，采用等级记分法，以达到正常肢体功能的百分数表示。对移植腓骨的转归，参照国际挽救肢体专题讨论会制定的“同种及带血管移植的放射学评价方法”进行结果评定。结果应用带血管腓骨移植修复骨缺损的远期效果因缺损类型的不同而存在较大差异。 9例先天性胫骨假关节患者，术后肢体功能恢复 65％，其中移植腓骨骨不连 1例、骨折 3例 (7次 )、成角畸形 5例； 3例先天性桡骨缺如患者，术后肢体功能恢复 62％， 3例术后均出现移植腓骨骨骺线早闭，畸形复发； 5例骨髓炎、骨外露、骨缺损并软组织缺损患者，术后肢体功能恢复 94％，仅 1例发生移植腓骨骨折； 1例前臂软组织缺损并尺骨缺损，尺神经、正中神经损伤者，术后肢体功能恢复 67％，骨愈合顺利； 1例桡骨海绵状血管瘤者，术后肢体功能恢复 100％，骨愈合顺利。结论带血管腓骨移植是修复长骨缺损的好方法，与其他组织瓣联合应用，可一次完成骨支架重建与软组织覆盖，有利于肢体功能的尽早恢复。但对先天性胫骨假关节和桡骨缺如患者 ,远期效果不甚理想。Objective To analyze the long- term results of vascularized fibular graft to repair defects of long bone. Methods Nineteen patients undergone vascularized fibular graft were followed- up for 5－ 20 years(mean 10.79 years). Limb function was graded with Enneking s system, and presented as percentage of normal limb function. The changes of the vascularized fibular graft were evaluated radiographically according to the International Symposium on Limb Salvage. Results The long term results of the vascularized fibular graft varied in different types of bone defects. Nine patients with congenital pseudoarthrosis of tibia had the limb function restored in 65％ and one had nonunion of fibular graft, 3 fractures(7 times), and 5 angular deformities. Three patients with congenital radial deficiency had 62％ restoration of the limb function. All of them showed early closure of epiphyses of the grafted fibulae. Five cases with osteomyelitis and bone defects combined soft tissue deficiency had 94％ restoration of the limb function, and only one occurred fracture of fibular graft. One case with soft tissue defect and concomitant ulnar defect, ulnar nerve and median nerve injury, 67％ function of limb was recovered, and union of fibula graft was good. 100％ function of limb was recovered in 1 case with cavernoma of radius and without occurring valgus deformity of donor site. Conclusion The vascularized fibular graft is a good method for repairing long segmental defects of bone. Combined with other tissue flap, the operation can reconstruct bone defect and fulfil the cover of soft tissue. For congenital tibia pseudoarthrosis and radial deficiency, the long- term results are not so satisfactory.

关 键 词：自体移植 四肢长骨缺损 带血管腓骨移植 

分 类 号：R687.34[医药卫生—骨科学]