游离腓骨皮瓣移植重建小腿长段骨及软组织缺损  

Free fibular flap transplantation for reconstruction of long leg bone defect with soft tissue defect

作　　者：窦义臣[1] 宣昭鹏[1] 傅东升[2] 路来金[1] DOU Yichen;XUAN Zhaopeng;FU Dongsheng(Department of Hand and Foot Surgery,The First Hospital of Jilin University,Jilin,Jilin,130021,China)

机构地区：[1]吉林大学第一医院手足外科,吉林吉林130021 [2]新疆医科大学附属第六医院,新疆维吾尔自治区乌鲁木齐830001

出　　处：《实用手外科杂志》2021年第4期447-450,共4页Journal of Practical Hand Surgery

摘　　要：目的探讨游离腓骨皮瓣移植重建小腿长段骨缺损伴软组织缺损的临床疗效。方法2017年5月-2019年12月,收治小腿长段骨缺损合并软组织缺损7例。均行急诊清创、外固定、骨水泥填充创口和VSD覆盖,二期应用带血管蒂的游离腓骨皮瓣重建骨的连续性并修复软组织缺损。切取健侧腓骨长度14~20 cm,附带皮瓣大小为15 cm×8 cm~23 cm×13 cm。腓骨皮瓣移植后均采用有限内固定+Ilizarov环形外固定支架固定。术后定期随访。结果本组7例术后皮瓣血运良好,肢体保全良好。术后随访8~16个月,平均9.4个月;7例皮瓣愈合均良好,无感染性窦道形成;3例术后2~3个月出现外固定支架针道感染,2例经盐水换药后感染得到控制,1例重新调整针道位置后感染愈合。移植腓骨愈合良好,愈合时间3~7个月,平均4.6个月,随访期间无压力性骨折发生。骨愈合后,末次随访采用Johner-Wruhs下肢功能评分标准评价:优1例,良5例,差1例,优良率为85.5%。结论带血管蒂的游离腓骨皮瓣移植是修复小腿长段骨缺损伴软组织缺损的有效方法,具有一次同时修复骨和皮肤缺损、骨端愈合速度快、疲劳骨折少、骨吸收发生少等优点。扎实的解剖知识、个体化的手术方案设计和熟练的手术技巧是手术成功的关键。Objective To investigate the clinical effects of free fibular flap transplantation for reconstruction of long bone defect with soft tissue defect of the leg.Methods From May 2017 to December 2019,7 cases of long leg bone defects with soft tissue defects were treated.In the second stage,free fibular flap with vascular pedicle was used to reconstruct the continuity of bone and repair the soft tissue defect.The length of fibula on the healthy side was 14 to 20 cm,and the size of flap was 15 cm×8 cm to 23 cm×13 cm.The fibular flap was fixed with limited internal fixation and Ilizarov external fixation.The patients were followed up regularly.Results In this group,7 cases had good blood circulation and limb preservation.The average follow-up time was 9.4 months;all the flaps healed well without infection of sinus;three patients developed infection of external fixation stent 2-3 months after operation,two patients were controlled after saline dressing change,and one patient healed after readjusting the position of the Kirschner wire.The healing time was 3-7 months,with an average of 4.6 months.There was no pressure fracture during the follow-up.After bone healing,Johner wruhs was used to evaluate the function of lower limbs in the last follow-up:excellent in 1 case,good in 5 cases,poor in 1 case,the excellent and good rate was 85.5%.Conclusion Free fibular flap with vascular pedicle is an effective method to repair long leg bone defect with soft tissue defect.It has the advantages of quick healing,less fatigue fracture and less bone absorption.The key to the success of the operation is to have a good knowledge of anatomy,individual surgical design and master surgical skills.

关 键 词：胫骨骨缺损 腓骨骨皮瓣 游离组织移植 创伤修复 外固定 

分 类 号：R658.3[医药卫生—外科学]