吻合血管的游离腓骨移植并一期胫骨延长治疗先天性胫骨假关节  

Treatment of congenital pseudarthrosis of tibia with free fibula graft with vascular anastomosis and primary tibial lengthening

作　　者：郑前进 欧学海 段虹昊[1] 徐思齐 Zheng Qianjin;Ou Xuehai;Duan Honghao(Ward I,Hand Center,the Affiliated Honghui Hospital of Xi'an JiaotongU niversity,Xi'an 710054,China)

机构地区：[1]西安交通大学附属红会医院手外中心一病区,710054

出　　处：《美中国际创伤杂志》2023年第2期36-39,共4页U.S.Chinese International Journal of Traumatology

摘　　要：目的:探讨吻合血管的游离游离腓骨移植并一期胫骨延长治疗先天性胫骨假关节近期临床效果。方法:2017年9月至2018年10月,采用吻合血管的腓骨移植加钢板内固定治疗先天性胫骨假关节患者4例,结合骨延长技术一期改善肢体短缩,其中男1例,女3例;年龄15-23岁,平均18.5岁,4例均采用游离排骨移植的方法修复,排骨切取长度6.0cm-14.0cm,平均9.2cm,术中将骨两端分别插入腔骨近侧和远侧段髓腔,辅以钢板固定后将动脉和胫前动脉吻合,使用半环型可延长外固定支架,每天延长1mm。结果:4例病人手术顺利,手术后6个月移植腓骨与腔骨愈合,腔骨延长区二周可见骨生长,4个月时骨质浓密,无神经血管并发症发生,4例下肢延长长度4.0cm-11.5cm.平均7.8cm,均恢复基本的行走功能。结论:采用病灶彻底切除长段吻合血管的游离排骨移植是治疗先天性胫骨假关节的有效方法,结合一期骨延长可以改善肢体短缩畸形。Objective:To evaluate the short-term clinical effect of free fibula transplantation with vascular anastomosis and primary tibial lengthening for the treatment of congenital pseudarthrosis of tibia.Methods:September 2017 to October 2018,there were 1 male and 3 female,aged 15-23 years(mean 18.5 years).four cases of congenital pseudarthrosis of tibia were treated with vascularized fibula transplantation and plate internal fixation,combined with bone lengthening technique to improve limb shortening.All cases were repaired by free fibula transplantation,the length of fibula was 6.0cm-14.0cm with an average of 9.2cm.The fibula was inserted into the proximal and distal medullary cavity of the tibia,and the fibular artery was anastomosed with the anterior tibial artery after plate fixation,and the semi-annular external fixator can be extended by lmm per day.Results:The transplanted fibula and tibia of all patients healed 6 months after operation,and bone growth could be seen in the tibia lengthening area 2 weeks after operation.At 4 months,the bone was dense and no neurovascular complications occurred.The length of lower limb lengthened from 4.Ocm to 11.5cm,average 7.8cm,all recovered basic walking function.Conclusion:The treatment of congenital pseudarthrosis of the tibia with free fibula transplantation is an effective method,combined with primary bone lengthening can improve the limb shortening deformity.

关 键 词：先天性胫骨假关节 游离腓骨移植:骨延长 

分 类 号：R68[医药卫生—骨科学]