两种不同方式髂骨瓣游离移植在胫骨骨缺损修复中的应用  

Two different methods of free iliac flap grafting in the repair of tibial defect

作　　者：周丕育 杨绍浦 李尚权 苏期波 马元俊 黄振华 张林虎 赵亮 黄江 王召华 刘波 郑青松 张钦超 张勇 Zhou Piyu;Yang Shaopu;Li Shangquan;Su Qibo;Ma Yuanjun;Huang Zhenhua;Zhang Linhu;Zhao Liang;Huang Jiang;Wang Zhaohua;Liu bo;Zheng Qingsong;Zhang Qinchao;Zhang Yong(The People’s Hospital of Zun Yi City Bo Zhou District(The People’Hospital of Original Zun Yi County)Department of Plastic Hand-Foot Orthopedic Trauma,Zunyi 563100,China)

机构地区：[1]贵州省遵义市播州区人民医院(原遵义县人民医院)整形手足创伤骨科,563100

出　　处：《中华整形外科杂志》2019年第12期1230-1233,共4页Chinese Journal of Plastic Surgery

摘　　要：目的探讨旋髂深血管蒂髂骨皮瓣或阔筋膜张肌复合髂骨皮瓣,治疗胫骨长节段骨缺损的临床效果。方法本组16例均为2012年2月至2017年8月就诊于遵义市播州区人民医院的胫骨缺损患者,男11例,女5例,年龄22~58岁,平均42岁。单纯胫骨缺损4例,合并皮肤缺损12例,胫骨缺损最长5~8 cm。应用旋髂深血管带髂骨皮瓣或阔筋膜张肌复合髂骨皮瓣进行修复。结果应用旋髂深血管蒂髂骨皮瓣植骨治疗4例,皮瓣面积2.5 cm×5.0 cm^5.0 cm×10.0 cm,髂骨瓣5.0 cm×2.5 cm^8.0 cm×4.0 cm;应用阔筋膜张肌复合髂骨皮瓣修复12例,皮瓣面积5.0 cm×12.0 cm^12.0 cm×23.0 cm,髂骨瓣7.0 cm×2.0 cm^8.0 cm×4.0 cm。16例骨皮瓣全部成活,骨折愈合,无手术并发症。平均随访1.5年,皮瓣外形良好10例,稍臃肿6例,14例踝关节活动正常,2例背伸稍差,X线片示骨瓣修复骨性缺损均达骨性愈合。结论旋髂深血管蒂髂骨皮瓣植骨或带血运的阔筋膜张肌复合髂骨皮瓣,局部血供好,可加速骨折愈合,临床修复效果好。Objcetive To explore the treatment of long segment defect of tibia by using tensor fascia lata combined with iliac flap or deep circumflex iliac pedicle iliac flap.Methods From February 2012 to August 2017,The People′s Hospital of Zun Yi City Bo Zhou District treated 16 patients who had long segment defect of tibia.There were 11 males and 5 females,age from 22 to 58 years old,the average age was 42 years old.Iliac flap grafting with tensor fascia lata combined with iliac flap or deep circumflex iliac pedicle was used to treat the defect of long segment of tibia.There were 4 cases with simple tibial defect and 12 cases with skin defect.The longest tibial defect was 5-8 cm.Results In this study,four patients used iliac flaps with deep circumflex iliac pedicle,the area of flaps ranged from 2.5 cm×5.0 cm to 5.0 cm×10.0 cm,while the area of iliac flaps ranged from 5.0 cm×2.5 cm to 8.0 cm×4.0 cm.Twelve patients used grafting with tensor fascia lata combined with iliac flap,the area of flaps ranged from 5.0 cm×12.0 cm to 12.0 cm×23.0 cm,while the area of iliac flaps ranged from 7.0 cm×2.0 cm to 8.0 cm×4.0 cm.All 16 cases of bone flap were survived,fracture healing,without surgical complications.The average follow-up period was 1.5 years,the flaps had good appearance in 10 cases and was slightly bloated in 6 cases;the ankle had normal motion in 14 cases and had poor dorsal extension in 2 cases.X-ray films showed that the bone flap repaired the bone defects and reached bone healing.Conclusions Vascularized tensor fascia lata combined with iliac flap or deep circumflex iliac pedicle iliac flap grafts increase local blood supply and accelerate the process of fracture healing.

关 键 词：游离移植 阔筋膜张肌 骼骨瓣 

分 类 号：R687[医药卫生—骨科学] R65[医药卫生—外科学]