带血管腓骨移植修复四肢大段骨缺损:可有效促进骨愈合  

Vascularized fibular graft for repair of large segmental bone defects in the extremities

作　　者：李远辉[1] 杨运发[2] 胡汉生[1] 张光明[2] 余升华[1] 曾勉东[1] 范震波[1] 

机构地区：[1]广州医科大学附属第三医院骨科,广东省广州市510150 [2]广州市第一人民医院创伤外科,广东省广州市510180

出　　处：《中国组织工程研究》2015年第11期1641-1646,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:研究表明,带血管腓骨移植是修复四肢大段骨缺损的有效方法之一。目的:分析带血管腓骨移植修复四肢大段骨缺损的临床效果。方法:采用腓骨移植修复四肢大段骨缺损病例中选择非恶性肿瘤、随访20个月以上病例28例,清除病灶后应用带血管腓骨移植修复大段骨缺损,对于合并软组织缺损的病例同时用腓骨皮瓣或股前外侧皮瓣覆盖。结果与结论:所有病例随访20个月至6年,移植腓骨后3-8个月与受区骨达到骨愈合,术后10-22个月移植腓骨直径增粗致接近受区骨直径。Enneking系统评价肢体功能:胫骨大段骨缺损平均24.2分,肢体功能恢复81%,患者对手术满意程度达94%;股骨骨缺损平均26.3分,肢体功能恢复88%,患者对手术满意程度100%;桡尺骨远端骨缺损平均21.75分,肢体功能恢复72%,患者对手术满意程度100%。结果表明应用带血管腓骨移植修复四肢大段骨缺损可有效促进骨缺损愈合,降低致残、感染及截肢率,治疗后患者对肢体功能恢复满意。BACKGROUND：Vascularuzed fibular graft is one of the effective methods for repair of large segmental bone defects in the extremities OBJECTIVE：To explore the clinical effects of vascularized fibular graft for repairing large segmental bone defects in the extremities. METHODS：Twenty-eight non-malignant patients who received vascularized fibular graft for repairing large segmental bone defects in the extremities and were folowed up for more than 20 months were enroled. After lesion removal, vascularized fibula bone graft was used to repair the bone defects. If cases combined with soft tissue defects, fibula flap or anterolateral thigh flap was adopted. RESULTS AND CONCLUSION： Al patients were folowed up for 20 months to 6 years. The grafted bones were healed with the surrounding bone at 3-8 months after fibula bone grafting. The grafted bone was enlarged near to the diameter of recipient bone at 10-22 months after grafting. Based on the Enneking system, the average score of large segmental tibia bone defects was 24.2 points with 81% limb function recovered and 94.1% patient satisfaction; the average score of large segmental femur bone defects was 26.3 points with 87.7% limb function recovered and 100% patient satisfaction; the average score of large segmental bone defects of the distal radius and ulna was 21.75 points with 72.5% limb function recovered and 100% patient satisfaction. These findings reveal that vascularized fibular graft for repairing large segmental bone defects in extremities can effectively promote bone healing and reduce disability, infection, amputation rate; moreover, patients are satisfied with the postoperative recovery of limb function.

关 键 词：组织构建 骨组织工程 腓骨移植 骨缺损 四肢 显微外科手术 

分 类 号：R318[医药卫生—生物医学工程]