摘要
目的探讨带血管蒂游离腓骨移植术治疗股骨远端骨缺损的临床安全性和有效性。方法回顾性分析自2007-03—2019-08采用带血管蒂游离腓骨移植术治疗的12例股骨远端骨缺损,交通事故伤导致股骨远端粉碎性骨折并骨缺损6例,高处坠落伤导致股骨远端粉碎性骨折并骨缺损3例,股骨远端骨折术后骨不愈合导致骨缺损2例,股骨远端骨折术后骨髓炎导致骨缺损1例。将带血管蒂腓骨瓣植入股骨缺损区,近端插入股骨干髓腔,远端插入股骨髁间,恢复股骨干长度后持骨钳钳夹固定,C型臂X线机透视确认下肢力线及股骨长度恢复良好后将股骨外侧解剖型钢板置于股骨外侧并使之贴伏,确保植骨端及内固定物稳定。结果12例均获得随访,随访时间平均24(12~78)个月。移植的带血管蒂腓骨于术后9~20周与股骨远端骨缺损处骨性愈合,骨性愈合时间平均15.7周。随访期间所有患者均未出现移植腓骨骨折、骨折不愈合、内固定失效、感染等并发症。末次随访时膝关节功能采用HSS评分标准评定:优7例,良4例,可1例。结论在严格把握手术适应证、选择适当的手术时机及合适内固定物的前提下,带血管蒂游离腓骨移植术治疗股骨远端骨缺损具有良好的可行性,能够为骨缺损处提供足够强度的支撑力和骨愈合能力。
Objective To explore the clinical safety and efficacy of free fibula transplantation with vascular pedicle in the treatment of distal femoral bone defects.Methods Twelve cases of distal femoral bone defects treated by vascularized free fibula transplantation from March 2007 to August 2019 were retrospectively analyzed.Six cases of distal femoral comminuted fractures with bone defects were caused by traffic accident injuries,3 cases of distal femoral comminuted fractures with bone defects by high fall injuries,2 cases of bone defects by bone nonunion after distal femoral fracture surgery,and 1 case of bone defects by osteomyelitis after distal femoral fracture surgery.The free fibula with vascular pedicle was transplanted into the femoral defect area,the proximal part was inserted proximal femoral shaft medullary cavity,and the distal part was inserted between the femoral condyles.The bone holding forceps were used for fixation after the length of femoral shaft was restored.After confirming that the lower limb alignment and femoral length were well recovered by C-arm X-ray machine,the anatomical plate of the lateral femur was placed on the lateral femur and attached to ensure the stability of the bone graft end and internal fixator.Results Twelve cases were followed up for an average of 24(12-78)months.The transplanted free fibula with vascular pedicle healed with the bone defects of the distal femur 9-20 weeks after operation,with an average bone healing time of 15.7 weeks.During the followup period,none of the patients had any complications such as fibular graft fracture,nonunion of fracture,failure of internal fixation and infection.At the last follow-up,the knee joint function was evaluated by HSS scoring standard:excellent in 7 cases,good in 4 cases,and fair in 1 case.Conclusion On the premise of strictly grasping the operation indications,selecting appropriate operation time and appropriate internal fixation,free fibular transplantation with vascular pedicle has good feasibility to treat distal femoral bone defects,which can provide sufficient strength of support and bone healing ability for bone defects.
作者
林小华
魏国桢
林培森
谢昀
LIN Xiao-hua;WEI Guo-zhen;LIN Pei-sen;XIE Yun(不详;Department of Orthopaedic,Fujian Medical University Affiliated Fuqing Hospital,Fuzhou,Fujian 350300,China)
出处
《中国骨与关节损伤杂志》
2022年第12期1243-1247,共5页
Chinese Journal of Bone and Joint Injury
基金
中国工程院院地合作项目(2021-FJ-xy-3)
福建省财政补助卫生专项基金(BPB-XY2021)。
关键词
股骨远端骨缺损
股骨远端粉碎性骨折
带血管蒂游离腓骨
骨移植
Bone defect in distal femur
Comminuted fracture of distal femur
Free fibula with vascular pedicle
Bone transplantation
