摘要
目的探讨游离带血管蒂腓骨移植(free vascularized fibular graft,fVFG)联合水平对置全长桥接钢板(parallel opposed plating,POP)固定技术在股骨大段骨干缺损生物重建失败后翻修治疗中的初步结果。方法2015年11月至2019年6月,笔者对5例股骨中段生物重建失败病例进行fVFG联合POP翻修手术。男3例,女2例。年龄5~21岁,平均13.8岁。肿瘤均位于股骨中段;缺损长度13~21 cm,平均18.2 cm;此次术前重建方式为:3例大段异体骨+钢板,2例大段异体骨+髓内针,其中1例联合不带血管腓骨移植;重建失败类型4例为异体骨-截骨端不愈合导致内固定折断,1例为异体骨-截骨端不愈合合并感染;2例近端骨端不愈合,2例远端骨端不愈合,1例两端均出现不愈合。结果术后伤口均I期愈合,无围术期并发症发生,翻修术前肢体不等长平均2.4 cm(0.5~6.0 cm),术后肢体不等长平均为2.7 cm(1.0~6.2 cm)。随访时间6~41个月,平均21.8个月。截骨端愈合时间8~15个月,平均10.2个月,腓骨与自体骨开始出现融合时间为6~12个月,平均8.1个月。骨扫描均可见移植腓骨骨代谢显影。末次随访MSTS 93功能评分56.7%~83.3%,平均76.2%。5例中4例可独立行走,1例扶单拐行走。结论对于股骨中段大段骨缺损生物重建失败病例,可以通过fVFG联合POP内固定技术进行翻修,稳定性及活性均可得到可靠重建。
Objective To ascertain the preliminary results of revision surgery after the non-union following biological reconstruction of the femoral intercalary defects by free vascularized fibular graft(fVFG)combined with parallel opposed plating(POP).Methods Five patients underwent fVFG combined with POP between Nov.2015 and Jun.2019,including 3 males and 2 females with an average age of 13.8 years(range:5-21 years).All primary tumors located in the middle femoral shaft with an average bone defect of 18.2 cm(range:13-21 cm).Initial reconstructions:allograft+plates in 3 patients;allograft+intramedullary nail in 2 patients;non-vascularized fibular was used in1 patient among them.Mechanical failure due to the non-union at the conjunction was observed in 4 patients,while1 patient had mechanical failure and infection.The non-union at the proximal junction occurred in 2 patients,at the distal junction in 2 patients.Two ends non-union was found in one patient.Results Preliminary healing was observed in all patients without perioperative complications.The mean leg length discrepancy(LLD)was 2.4 cm(range:0.5-6.0 cm)preoperatively and 2.7 cm(range:1.0-6.2 cm)postoperatively.The mean follow-up was 21.8 months(range:6-41 months).The mean bone union time was 10.2 months(range:8-15 months).The fibular fusion with the allograft averaged 8.1 months(range:6-12 months).Bone metabolism of the transplanted fibula was revealed by the bone scan.The mean MSTS 93 was 76.2%with a range of 56.7%-83.3%.Four patients could walk independently,while 1 on crutch.Conclusions fVFG combined with POP is reliable after failed intercalary reconstruction.The preliminary results are promising,however,long-term follow-up is needed.
作者
姬涛
邢志利
汤小东
杨荣利
郭卫
JI Tao;XING Zhi-li;TANG Xiao-dong;YANG Rong-li;GUO Wei(Musculoskeletal Tumor Center,Peking University People's Hospital,Beijing,100044,China)
出处
《中国骨与关节杂志》
CAS
2020年第5期324-328,共5页
Chinese Journal of Bone and Joint
关键词
股骨
骨干
腓骨
骨移植
骨肿瘤
矫形外科手术
骨缺损
Femur
Diaphyses
Fibula
Bone transplantation
Bone neoplasms
Orthopedic procedure
Bone defects
