胫前动脉返支为蒂游离腓骨头骺移植治疗Bayne-KlugⅡ、Ⅲ型先天性桡骨发育不良  

Clinical research of vascularized fibular head epiphyseal transfer for Bayne and Klug typeⅡandⅢcongenital radial dysplasia

作　　者：刘畅[1] 陈山林[1] 薛云皓[1] 栗鹏程[1] 童德迪[1] 杨辰[1] Liu Chang;Chen Shanlin;Xue Yunhao;Li Pengcheng;Tong Dedi;Yang Chen(Department of Hand Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院手外科,100035

出　　处：《中华整形外科杂志》2021年第9期968-975,共8页Chinese Journal of Plastic Surgery

摘　　要：目的探讨以胫前动脉返支为蒂的游离腓骨头骺移植治疗儿童Bayne-KlugⅡ、Ⅲ型先天性桡骨发育不良的临床效果。方法分析2013年2月至2018年9月北京积水潭医院采用以胫前动脉返支为蒂的游离腓骨头骺移植治疗的Bayne-KlugⅡ、Ⅲ型先天性桡骨发育不良患儿资料。患儿均分期进行手术治疗:(1)术前通过按摩以及牵引支具逐渐牵拉桡侧软组织以及腕关节,最大化桡侧间隙。(2)取同侧下肢的腓骨头,以胫前动脉返支为蒂的游离腓骨头骺骨瓣移植重建桡骨远端以及腕关节的稳定结构。(3)至少6个月后,对于BlauthⅣ型及以上拇指发育不良的患儿进行示指拇化手术。通过测量桡偏角、腓骨生长长度以及桡骨/尺骨长度比来评估治疗效果。结果共纳入4例男性患儿,均右侧受累,年龄16~62个月龄,平均30.5个月龄。术后随访19~78个月,平均40.5个月。3例患儿伴BlauthⅣ型或Ⅴ型拇指发育不良,于游离腓骨头骺移植术后1年左右行示指拇化术。移植骨均顺利骨性愈合;桡偏角度平均纠正24°;重建的桡骨远端均获得了一定的生长,取板时的桡骨长度较术后6周时平均增长13.2%;桡骨/尺骨长度比较术前平均改善13.3%。结论采用胫前动脉返支为蒂的腓骨头骺瓣治疗Bayne-KlugⅡ、Ⅲ型桡骨发育不良,重建桡骨远端具有纵向生长能力,可有效矫正桡偏畸形,避免畸形的进一步发展。Objective To investigate the clinical effect of free fibular head epiphysis transplantation pedicled with the recurrent branch of the anterior tibial artery in the treatment of children with Bayne-KlugⅡ-Ⅲcongenital radial dysplasia.Methods From February 2013 to September 2018,we retrospectively reviewed and analyzed our prospective database of four patients with Bayne-Klug typeⅡ-Ⅲcongenital radius dysplasia referred to Beijing Jishuitan Hospital for consideration of free fibular head epiphysis transplantation.All children underwent surgical treatment by stages:(1)Before surgery,the radial soft tissue and wrist joint were gradually stretched by massage and traction braced to maximize the radial space.(2)A free fibular head pedicled with the recurrent branch of the anterior tibial artery was harvested from the ipsilateral lower limb and transferred as a vascularized fibular head composite flap for reconstructing the stable structure of the distal radius and wrist joint.(3)At least six months after the procedure,pollicization was performed on Blauth typeⅣandⅤ.The treatment effect was evaluated by measuring the radial deviation angle,the growth length of the fibula,and the ratio of the radius/ulna length.Results A total of 4 boys with right side deformity were enrolled.The ages of the patients ranged from 16 to 62 months,with an average of 30.5 months.The post-operative follow-up period was 19 to 78 months,with an average of 40.5 months.Three children with Blauth typeⅣorⅤthumb dysplasia were performed with pollicization about one year after free fibular head epiphysis transplantation.All the grafted bones healed;the radial deviation angle was corrected by an average of 24°;the reconstructed distal radius grew longer,with an average increase of 13.2%when the plate was removed compared with six weeks post-operatively;the ratio of the radius/ulna was an average increase of 13.3%compared with preoperative.Conclusions The use of fibular head epiphyseal flap pedicled with the recurrent branch of the anteri

关 键 词：先天性桡骨发育不良 腓骨头 骨移植 胫前动脉返支 

分 类 号：R726.8[医药卫生—儿科]