游离髂骨移植重建外踝的临床研究  

Reconstruction of lateral malleolus with a free iliac bone graft

作　　者：杜全红[1] 史永安[1] 丛海波[2] 隋海明[1] 翟建国[1] 杨庆民 迟涛胜 马秉珺[1] 

机构地区：[1]山东省威海市文登整骨医院骨、手显微外科,264400 [2]山东省威海市文登中心医院,264400

出　　处：《中华创伤骨科杂志》2016年第6期493-497,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨采用游离髂骨移植重建外踝的临床疗效。方法回顾性分析2010年6月至2012年4月因外伤导致外踝骨、皮肤缺损的5例患者资料，男3例，女2例；年龄23。56岁，平均35．4岁。骨缺损部位：左侧2例，右侧3例，骨缺损均为下胫腓韧带以远，骨缺损长度3．2-4．5cm。采用分期治疗：一期行游离皮瓣移植修复创面，二期行游离髂骨移植重建外踝。结果5例一期游离皮瓣移植全部成活。随访时间33-38个月，平均35．4个月；骨愈合时间5．5—8．0个月，平均6．8个月。术中发现距骨外侧关节面有部分剥脱的1例患者术后11个月出现关节炎表现，术后35个月随访有跛行步态；余4例未见明显跛行步态和疼痛，踝关节活动度接近正常，关节面匹配，关节间隙正常，无二次骨折发生，末次随访时根据美国足踝外科协会的踝．后足评分均大于90分。结论游离髂骨移植重建外踝临床疗效肯定，远期随访效果理想。Objective To explore reconstruction of lateral malleolus with a free iliac bone graft. Methods The clinical data of 5 patients with traumatic compound loss of lateral malleolus and skin were retrospectively analyzed who had been treated at our department from June 2010 to April 2012. They were 3 males and 2 females, 23 to 56 years of age （average, 35.4 years）. The bone defect was on the left side in 2 cases, on the right side in 3 cases, and beyond the inferior syndesmosis in all. The bone defects ranged from 3.2 cm to 4. 5 cm in length. In the staged treatment, the wounds were repaired by free skin flap transplan- tation in the first stage while the lateral malleolus defects were rebuilt with a free iliac bone graft in the second stage. Results The skin flaps survived primarily in all the 5 cases. All the cases were followed up for 33 to 38 months （average, 35.4 months） . The bone healing time was from 5.5 to 8.0 months （average, 6.8 months）. Arthritis occurred 11 months after surgery and limping gait was found 35 months after surgery in one case whose lateral articular surface of the talus was found partially stripped intraoperatively. No limping gait or pain was found in the other 4 cases who obtained a stable ankle with nearly a full range of motion. Their joint surface was matching, and their joint clearance was normal. No secondary fractures occurred. According to the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale, they scored more than 90 points at the final follow-ups. Conclusion Reconstruction of lateral malleolus with a free iliac bone graft can lead to positive therapeutic effects and ideal long-term outcomes.

关 键 词：踝 创伤和损伤 髂骨 修复外科手术 移植 

分 类 号：R687.3[医药卫生—骨科学]