异体骨重建带血管腓骨移植后供区骨缺损的效果分析  

Clinical evaluation of allograft for reconstruction of donor-site bone defect after vascularized fibula harvest

作　　者：黄孟全 鲁亚杰 龙作尧 姬传磊 李明辉 肖鑫 陈国景 李靖 HUANG Meng-quan;LU Ya-jie;LONG Zuo-yao;JI Chuan-lei;LI Ming-hui;XIAO Xin;CHEN Guo-jing;LI Jing(Department of Orthopedics,the First Affiliated Hospital of Air Force Medical University,Xi'an,Shaanxi 710032,China)

机构地区：[1]空军军医大学第一附属医院骨科,陕西西安710032

出　　处：《中国骨与关节损伤杂志》2020年第12期1257-1260,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的观察采用大段异体骨重建带血管腓骨移植后供区骨缺损的临床效果,探讨重建腓骨缺损后能否减少供区并发症发生。方法回顾性分析自2012-10—2018-12因肱骨、股骨病变部位切除后骨缺损需切取带血管腓骨移植重建的18例患者,按是否对腓骨供区骨缺损进行重建分为重建组(11例)与未重建组(7例)。比较2组术后PES评分、外踝上移程度、距骨倾斜角变化程度、踝关节各方向活动度。结果 18例均获得随访,随访时间平均33.7(9~78)个月。重建组术后PES评分低于未重建组,外踝上移程度、距骨倾斜角变化程度小于未重建组,差异有统计学意义(P <0.05)。重建组踝关节内翻活动度占健侧比值大于未重建组,差异有统计学意义(P <0.05);而2组踝关节背伸、跖屈、外翻活动度占健侧比值差异无统计学意义(P>0.05)。结论采用大段异体骨对带血管腓骨移植后供区骨缺损进行重建可以减少远端腓骨上移与距骨倾斜角改变,减少供区并发症发生,改善踝关节内翻活动度,同时不增加感染风险。Objective To evaluate the clinical efficacy of allograft for the reconstruction of donor-site bone defect after vascularized fibula harvest and to explore whether reconstruction of donor-site bone defect can reduce donor complications.Methods A retrospective analysis was performed on 18 patients with bone defects of humerus and femur after resection and reconstruction with vascularized fibula transplantation between October 2012 and December 2018.According to whether the fibular donor-site bone defect was reconstructed,the patients were divided into the reconstruction group(11 cases)and the non-reconstruction group(7 cases).PES score,lateral malleolus displacement,talar tilt angle and ankle joint mobility were compared between the two groups.Results All patients were followed up for an average of 33.7(range 9-78)months.Postoperative PES score of the reconstruction group was significantly lower than that of the non-reconstruction group(P<0.05).The lateral malleolus displacement and the change of talar tilt angle in the reconstruction group were less than those in the non-reconstruction group,with statistical significance(P<0.05).The mobility of ankle varus ratio of the occupied side in reconstruction group was greater than that in non-reconstruction group(P<0.05),but there was no significant difference in ankle dorsiflexion,plantar flexion and valgus ratio of the occupied side between the two groups(P>0.05).Conclusion The reconstruction of donor-site bone defect with allograft after vascularized fibula harvest can reduce the risk of postoperative complications such as distal fibula displacement and talus inclination,improve the of ankle varus mobility without increase of the risk of infection.

关 键 词：带血管腓骨移植术 腓骨缺损 大段异体骨 骨重建 供区并发症 

分 类 号：K687.3[历史地理—历史学]