组织移植结合Ilizarov骨牵张技术重建下肢骨与软组织缺损  

Tissue transplantation combined with Ilizarov distraction technique to reconstruct bone and soft tissue defects in lower limb

作　　者：任义军 胡锐[2] 严立 赵晶晶[2] 陈森[1] 金志辉 叶佳[1] 陈任[1] REN Yijun;HU Rui;YAN Li;ZHAO Jingjing;CHEN Sen;JIN Zhihui;YE Jia;CHEN Ren(Department of Traumatic Orthopedics,East Part of Renmin Hospital of Wuhan University,Wuhan 430060,China;Department of Reparative and Reconstructive Surgery,Puai Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430033,China)

机构地区：[1]武汉大学人民医院东院创伤骨科,武汉430060 [2]华中科技大学同济医学院附属普爱医院修复重建外科,武汉430033

出　　处：《中华显微外科杂志》2020年第3期233-237,共5页Chinese Journal of Microsurgery

摘　　要：目的探讨组织移植结合Ilizarov骨牵张技术重建下肢解剖结构、恢复下肢功能的临床疗效。方法2010年10月-2019年4月,应用组织移植结合Ilizarov骨牵张技术重建患肢解剖结构及功能治疗51例,其中胫骨近端缺损17例、胫骨远端缺损27例、跟骨部分缺损4例、前足跖骨缺损3例。手术分期进行,一期组织瓣移植覆盖创面,切取游离股前外侧皮瓣33例、腹股沟皮瓣8例、股前内侧皮瓣5例、胸脐皮瓣3例、背阔肌皮瓣2例,切取面积3.5 cm×15.0 cm^8.0 cm×25.0 cm;二期安装Ilizarov环形架或自行设计的牵张器,采用Ilizarov环形架44例、自行设计牵张器7例。术后定期随访。结果1例股前外侧皮瓣部分坏死,3例皮瓣术后感染,其余47例皮瓣全部成活。36例胫骨采用骨搬运方法修复骨缺损,8例采用骨搬运与肢体延长结合恢复长度,4例跟骨采用横行或纵向牵张恢复跟骨外形,3例前足跖骨缺损采用纵向或横行牵张恢复足弓。随访9个月~2年,无骨髓炎复发,骨搬运对合端及延长区均获骨性愈合。按Paley骨性评分标准评定,结果优良率为98.0%,按生活质量评价表SF-36评分平均88.9分,按美国踝关节外科协会(AOFAS)评分平均79.5分。结论组织移植结合Ilizarov技术可重建下肢骨与软组织缺损,最大程度恢复患肢功能。Objective To investigate the therapeutic effect of tissue transplantation combined with Ilizarov distraction technique in reconstruction of lower limb anatomical structure and the recovery of lower limb functions.Methods From October,2010 to April,2019,tissue transplantation combined with Ilizarov distraction technique was used to reconstruct the anatomical structures and functions of 51 lower limb defects,including 17 in proximal tibia,27 in distal tibia,4 partial defects of calcaneus and 3 in metatarsal bones.Surgical operations were carried out in 2 phases.Transplantation of free flaps to cover the wound surface was performed in the first phase.Thirty-three free anterolateral femoral flaps,8 groin flaps,5 anterolateral medial femoral flaps,3 thoracic umbilical flaps,and 2 alissimus dorsi musculocutaneous flaps were transplanted,with the sizes ranged from 3.5 cm×15.0 cm to 8.0 cm×25.0 cm.In the second phase,Ilizarov ring rack or customer-designed distractor were applied/employed and 44 cases applied with Ilizarov ring racks and 7 cases with self-designed distractors.Regular postoperative followed-up.Results All flaps survived.There was 1 partial necrosis on the anterolateral femoral flap and 3 postoperative infections.Bone transport was applied to repair 36 tibia defects,bone transport combined with limb extension to restore the length of limb in 8 cases,bone transverse or longitudinal distraction was applied to restore the shape of calcaneus in 4 cases,and longitudinal or transverse distraction was applied to restore the foot arch in 3 cases with metatarsal defects.Followed-up for 9 months to 2 years.There was no recurrence of osteomyelitis after the second operation.Bone healings were achieved in the articulation ends and extension areas of bone transport.The excellent rate of Paley bone score was 98.0%,the average SF-36 score was 88.9,and the average AOFAS score was 79.5.Conclusion Tissue transplantation together with the Ilizarov technology is able to reconstruct a combined bone and soft tissue defect of

关 键 词：下肢 Ilizarov骨牵张技术 骨缺损 外科皮瓣 重建 

分 类 号：R658.3[医药卫生—外科学]