带血供与不带血供腓骨近端移植重建桡骨远端骨关节的回顾性分析  

Comparison outcomes of nonvascularized and vascularized fibular graft for distal radius bone and joint defect reconstruction： a retrospective study

作　　者：李文军[1] 张友乐[1] 陈山林[1] 杨博贵[2] 田文[1] 田光磊[1] 杨勇[1] 

机构地区：[1]北京积水潭医院手外科(北京大学第四临床医学院),北京100035 [2]解放军第二五一医院

出　　处：《中华显微外科杂志》2015年第1期41-47,共7页Chinese Journal of Microsurgery

基　　金：国家临床重点专科北京积水潭医院手外科专项基金资助（财社[2010]305号）

摘　　要：目的 回顾性研究带血供与不带血供腓骨近端移植重建桡骨远端骨关节的方法及疗效.方法 1966年11月-2009年3月,收治不同原因造成的桡骨远端骨与关节缺损患者27例,男9例,女18例,年龄16 - 67岁（平均27岁）.左侧14例,右侧12例,双侧l例.桡骨远端骨肿瘤切除后骨与关节缺损24例,桡骨远端AO C3型骨折3例,其中不愈合伴骨缺损2例,新鲜粉碎骨折骨块切除1例（双侧）.吻合血管的腓骨近端移植9例,不带血供的腓骨移植18例,断端采用钢板或螺钉加克氏针固定.术后采用DASH量表、Gartland和Werley（G/W）腕关节评分以及PRWE评分对重建的腕关节功能做出评价,并记录供区下肢功能改变情况.结果 27例均获随访,随访时间平均9年（3.5-44.0年）.带血供腓骨移植的长度平均10 cm（8 - 15 cm）,不带血供腓骨移植长度平均9 cm（6- 12 cm）.移植腓骨均顺利成活.骨愈合时间平均4.7个月（3-8个月）.随访期间肿瘤无复发.DASH量表评分2.5 - 17.0分（平均7.97分）;G/W腕关节评分24例1-2分,优占88.9％,3例5-7分,良占11.1％;握力恢复率75％-104％（平均85.81％）;PRWE评分10.5 - 38.0分（平均25.3分）.带血供与不带血供腓骨近端移植在骨愈合时间、DASH量表评分、G/W评分、握力恢复率以及PRWE评分上差异无统计学意义（P＞0.05）.3例患者供区下肢偶有微痛,占11.1％,但无行走功能障碍发生,1例术后11年发生骨折,经保守治疗治愈. 结论 腓骨近端移植是重建桡骨远端骨关节的理想方法之一,可以较好地保留腕关节功能;切取小于12 cm腓骨近端移植可不带血供,腓骨近端切取后不影响下肢功能.Objective To evaluate the method and outcomes of radiocarpal joint reconstruction via nonvascularized and vascularized fibular bone graft after distal radius bone and joint defect.Methods Between November,1966 and March,2009,27 cases with distal radius bone and joint defect due to tumor en bolc excision （24 cases） or AO C3 type fractures （3 cases） were treated with nonvascularized or vascularized fibular bone graft.There were 9 males and 18 females.The mean age of these patients at the time of surgery was 27 years （rage from 16 to 67 years）.There were 14 left sides and 12 right sides and 1 bilateral side.Nine cases with vascularized and 18 cases with nonvascularized fibular bone graft for radiocarpal joint reconstruction.The bone fixed with plate or/and k-wire.DASH scores,G/W wrist scores,PRWE scores were applied for writ function evaluation and the grasp power recovery rate and bone healing time was also compared during postoperative follow up.Results All 27 patients were followed with an average follow-up time being 9 years （range from 3.5 years to 44.0 years）.The average length of fibular bone harvested was 10 cm for vascularized bone graft and 9 cm for nonvascularized.The all fibular bone was healed and the average healing time was 4.7 months （range from 3-8 months）.No tumor recurrence or distance metastasis occurred during the follow-up.The average DASH scores was 7.97 （2.5-17.0）,G/W scores of 24 patients ranged from 1 to 2,the wrist function result was excellent,account for 88.9%,and 3 cases from 3 to 7,function was good,account for 11.1%; the average grasp power recovery rat was 85.81% （75%-104%）; the average PRWE scores were 25.3（10.5-38.0）.Comparison outcomes between the nonvascularized and vascularized fibular bone graft for radiocarpal wrist joint reconstruction,there was no significant statistics difference for bone healing time,DASH,G/W,PRWE scores and grasp power recovery rate （P 〉 0.05）.There were no other complications occurred except 3 patients had mild leg p

关 键 词：腓骨 桡骨 关节缺损 骨移植 桡腕关节 重建 

分 类 号：R687.3[医药卫生—骨科学]