以膝降动脉为蒂的股骨内侧髁骨膜瓣联合植骨治疗胫骨骨不连  

Treatment of tibial nonunions with medial femoral condyle periosteal flaps pedicled with descending genicular artery combined with bone graft

作　　者：邓伟[1] 巨积辉[1] 李雷[1] 周正虎[1] 李昌松 DENG Wei;JU Jihui;LI Lei;ZHOU Zhenghu;LI Changsong(Department of Orthopaedics and Trauma,Ruihua Affiliated Hospital of Soochow University,Suzhou,Jiangsu Province 215104,China)

机构地区：[1]苏州大学附属瑞华医院创伤骨科,江苏苏州215104

出　　处：《中华显微外科杂志》2020年第2期145-150,共6页Chinese Journal of Microsurgery

基　　金：江苏省青年医学人才项目(QNRC2016224)。

摘　　要：目的 探讨应用吻合血管的股骨内侧髁骨膜瓣联合植骨治疗胫骨骨不连的临床疗效.方法 2014年1月至2018年6月,共收治胫骨骨不连15例,均为Gustilo Ⅲ C型骨折术后骨不连,在受区获得较好的软组织覆盖后采取游离膝降动脉为蒂的股骨内侧髁骨膜瓣联合自体髂骨移植进行治疗,其中6例骨膜瓣膝降动脉与胫前动脉分支吻合,6例与胫后动脉分支吻合,3例与胫前动脉主干进行Flow-through式吻合,膝降动脉伴行静脉与胫前或胫后动脉伴行静脉进行端端吻合.术后常规抗炎、抗凝、抗痉挛处理,逐步行功能锻炼.定期随访,每月行X线片检查,了解骨折愈合情况.结果 术后随访6~29个月,平均11个月,其中14例获得骨性愈合,平均愈合时间5个月,1例随访6个月,骨折仍未愈合.术后6个月,根据Paley骨折愈合评价标准评定,优12例,良2例,差1例.15例患者中,14例均可完成正常的日常活动,1例因骨折未愈合,不能够完成日常活动,根据Paley功能恢复评定标准评定,优2例,良12例,差1例.结论 采用游离膝降动脉为蒂的股骨内侧髁骨膜瓣联合植骨治疗胫骨骨不连,供区隐蔽,切取简单,骨不连愈合率高,治疗周期短,有助于患者早期功能锻炼.Objective To investigate clinical effect of the descending genicular periosteal free flap combined with bone graft in the treatment of tibial nonunions.Methods From January,2014 to June,2018,15 cases of tibial nonunions were treated with the descending genicular corticoperiosteal free flaps combined with bone graft after soft tissue coverage.All patients had Gustilo III C fracture.In 6 cases,the descending genicular artery of periosteal flap was anastomosed with the branch of anterior tibia artery,6 cases anastomosed with the branch of posterior tibia artery,other 3 cases had Flow-through anastomosis with the main trunk of anterior tibia artery.The accompanying vein of descending geniculate artery was anastomosed with the vein of anterior tibia or posterior tibia artery.Routine treat-ment,step-by-step functional recovery exercises,monthly X-ray examination were conducted together with close ob-servation of the healing of fracture.Results All cases were followed-up from 6 to 29(average,11)months.Bone u-nion was achieved in 14 cases with the averager time of healing in 5 months.According to the evaluation criteria of Paley fracture healing,12 cases were excellent,2 were good and 1 was poor.Fourteen cases were able to take daily normal activities,and 1 case failed to take the daily activities because the fracture was not healed.Six months later,according to the results of Paley functional evaluation,2 cases were scored excellent,12 scored good and 1 scored poor.Conclusion The method of the descending genicular periosteal free flap combined with bone graft in the treatment of tibial nonunions can effectively improve the fracture union rate and reduce the patient treatment time with hidden donor area and simplicity of operation.It is helpful for the patients to take early exercises for the recovery of functions.

关 键 词：胫骨 股骨 骨膜瓣 骨不连 膝降动脉 骨移植 

分 类 号：R687[医药卫生—骨科学]