带监测皮岛的游离腓骨瓣移植治疗前臂骨缺损的手术技巧及疗效观察  

Transplantation of free fibular flap with monitoring flap for repair of forearm bone defect： surgical techniques and treatment outcome

作　　者：从飞[1] 范金柱[1] 宋涛[1] 欧学海[1] 张文韬[1] 付华[1] 张世辉[1] 杜晓龙[1] 陈勋[1] 喻姿瑞 刘洋[1] Cong Fei Fan Jinzhu Song Tao Ou Xuehai Zhang Wentao Fu Hua Zhang Shihui Du Xiaolong Chen Xun Yu Zirui Liu Yang.(Department of Orthopedics, Honghui Hospital, Xi＇an Jiaotong University , Xi＇an 710054, China)

机构地区：[1]西安交通大学医学院附属红会医院骨显微修复外科,西安710054

出　　处：《中华手外科杂志》2017年第4期293-296,共4页Chinese Journal of Hand Surgery

摘　　要：目的探讨带监测皮岛的游离腓骨瓣移植治疗前臂尺骨或桡骨骨缺损的手术技巧及疗效。方法自2005年2月至2016年1月，我们应用带监测皮岛的游离腓骨瓣移植治疗前臂骨缺损患者11例，其中尺骨2例，桡骨9例。缺损长度为3～10cm，平均5．0cm。结果术后11例患者监测皮岛均成活，无血管危象发生。一例监测皮岛术后出现张力性水泡，未做特殊处理，自行愈合。术后随访时间为6-36个月，平均14个月，移植骨愈合时间为3～10个月，平均5个月。腕关节和肘关节活动度与健侧基本相同，旋转功能较健侧均有受限，旋前0°-70°，旋后0°～50°。其中2例肿瘤患者肿瘤未见复发。有2例供区出现趾屈肌力下降，其余均无明显功能障碍。结论带监测皮岛的游离腓骨瓣移植治疗前臂骨缺损，骨瓣与受区匹配，愈合可靠，皮岛可以监测骨瓣血运及改善软组织条件，虽然技术较为复杂，有一定的手术风险，但仍是治疗前臂骨缺损的理想方法。Objective To explore the treatment outcome and surgical techniques of free fibular flap with monitoring flap for repair of forearm ulna or radius defect. Methods From February 2005 to January 2016, free fibular flap transplantation with monitoring flap was applied to repair forearm bone defect in 11 cases. There were 2 cases with ulna defect and 9 eases with radius defect. The range of defect was 3 to 10 em in length with an average of 5.0 cm. Results All 11 monitoring flaps survived, and no vascular crisis occurred. The monitoring flap of one case had blister and healed spontaneously. All the patients were follow-up for 6 to 36 months （average, 14 months）. The bone graft healing time was 3 to 10 months （average, 5 months）. The ranges of wrist and elbow joint motion were almost the same as those of the uninjured side, while the rotate functions were limited. The range of pronation was 0° to 70° and that of supination was 0° to 50°. Two cases of patients with tumor had no tumor recurrence. The donor site had no significantly dysfunction except two cases with toe flexor strength declining. Conclusion Despite the technical difficulty and operation risk, transplantation of free fibular flap with monitoring flap is an ideal method to repair forearm bone defect. The skin island can monitor the blood flow of bone flap and improve the soft tissue conditions to achieve reliable healing.

关 键 词：移植 前臂损伤 腓骨瓣 骨缺损 

分 类 号：R658.2[医药卫生—外科学]