吻合血管游离腓骨移植修复股骨近端及远端骨折术后感染性骨缺损  

Vascularised free fibular bone grafting in reconstruction of infectious bone defects after surgery for proximal and distal femoral fractures

作　　者：阿不来提·阿不拉[1] 刘凯 任鹏[1] 马创[1] 阿里木江·阿不来提[1] 艾合买提江·玉素甫[1] ABULAITI Abula;LIU Kai;REN Peng;MA Chuang;ALIMUJIANG Abulaiti;AIHEMAITIJIANG Yusufu(Department of Trauma and Microreconstructive Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院骨科中心显微修复外科,乌鲁木齐830054

出　　处：《中华显微外科杂志》2024年第5期544-548,共5页Chinese Journal of Microsurgery

基　　金：新疆维吾尔自治区"天山英才"医药卫生高层次人才培养计划(TSYC202301B070,TSYC202301B056)。

摘　　要：目的探讨吻合血管游离腓骨移植治疗股骨近端及远端骨折术后感染性骨缺损的临床疗效。方法回顾性分析2010年12月至2022年12月新疆医科大学第一附属医院骨科中心显微修复外科接受携带腓动、静脉为蒂的游离腓骨移植治疗股骨骨缺损的27例患者的临床资料,患者年龄17~72岁,平均41.7岁。其中,男21例,女6例;右侧21例,左侧6例。骨缺损长度5.0~9.0 cm,平均6.6 cm;移植腓骨长度5.0~14.0 cm,平均6.8 cm。手术前、后行规范抗生素药物治疗,供区给予逐层缝合。术后1、3、6、12、18及24个月复查患肢X线片,观察移植腓骨与股骨愈合情况,决定完全负重及拆架时间。出院前指导患者进行钉道护理预防感染,门诊或电话随访监测患者心理状态,运用Enneking下肢功能评分系统评估患肢功能恢复情况。结果27例患者术后随访19~34个月,平均26.1个月,移植腓骨均成活并达到骨性连接。骨愈合时间5.1~8.8个月,平均7.1个月。25例患者受区伤口一期愈合,2例患者股骨远端骨缺损引流管口形成窦道伴分泌物,细菌培养结果阴性,经门诊清创换药后愈合。所有患者移植腓骨未观察到应力骨折,受区未见感染复发。末次随访时Enneking下肢功能评分22~27分,平均23.7分。结论吻合血管游离腓骨移植是修复股骨近端及远端骨折术后感染性骨缺损的切实可行方法,可为骨缺损处提供可靠的固定和满意的骨愈合能力,有利于移植腓骨愈合及下肢功能恢复。Objective To investigate the clinical effect of vascularised free fibula transfer in the treatment of infectious bone defects after the surgery of proximal and distal femoral fractures.Methods The clinical data of 27 patients with femoral bone defects treated by vascularised free fibulae grafting with fibular artery and vein as pedicle from December 2010 to December 2022 were retrospectively analysed in the Department of Trauma and Microreconstructive Surgery,the First Affiliated Hospital of Xinjiang Medical University.There were 21 males and 6 females,at 17-72 years old,with a mean age of 41.7 years old.Twenty-one patients had bone defect of right femurs and 6 of left femurs.The length of bone defect ranged from 5.0 cm to 9.0 cm,with an average of 6.6 cm.The length of transferred fibulae ranged from 5.0 cm to 14.0 cm,with an average of 6.8 cm.Donor sites were carefully sutured layer by layer,and standardised antibiotic therapy was given before and after surgery.X-ray reviews of the affected limbs were taken at 1,3,6,12,18 and 24 months after surgery to observe the healing of the transferred fibulae and femurs to evaluate the time for full weight-bearing and removal of external frames.Before discharge,the patients were instructed to carry out pin tract care for prevention of infection.The psychological status of the patients was monitored at outpatient clinic or telephone interviews,and the functional recovery of the affected limbs was assessed using the Enneking lower limb function scoring system.Results All of 27 patients were included in the postoperative follow-up from 19 months to 34 months,with a mean time of 26.1 months.The transferred fibulae survived with bone union.The bone healing time was from 5.1 months to 8.8 months,with an average of 7.1 months.Twenty-five patients had primary healing of the recipient site wound,and 2 patients had a sinus formed at the orifice of drainage with secretion,and the results of bacterial culture were negative.The sinuses healed after cleaning and dressing change at outpa

关 键 词：股骨 骨折相关感染 骨缺损 腓骨移植 

分 类 号：R687.3[医药卫生—骨科学]