摘要
背景:应用吻合血管的游离腓骨移植治疗长管骨大段骨缺损疗效可靠,尤其是带监测皮岛的腓骨移植疗效更可靠,然而单腓骨移植修复负重长管骨则有折断的可能。目的:探讨带监测皮岛的组合腓骨移植治疗股骨大段缺损的临床疗效。设计:自身前后对照观察。单位:广州市第一人民医院骨科脊柱外科。对象:选择1995-07/2003-11广州市第一人民医院骨科脊柱外科收治的股骨骨缺损患者14例。部位:股骨下端5例,股骨中段9例,骨缺损长度6～28cm。干预:带监测皮岛腓骨折断成双腓骨移植7例,带监测皮岛腓骨捆绑同种异体骨7例。监测皮岛大小3cm×5cm,切取腓骨长度16～32cm。同种异体干冻骨长度12～28cm。术后监测手术伤口及监测皮岛情况。主要观察指标:患者骨缺损处带监测皮岛双腓骨或捆绑同种异体骨复合移植皮瓣成活情况、移植骨形态变化及负重行走能力。结果:14例患者均进入结果分析。双腓骨组7例随访3年,捆绑同种异体骨组7例随访1年。14例监测皮岛全部成活,捆绑同种异体骨组1例术后3个月有黄色渗液而取出异体骨,其余6例随访显示移植腓骨与异体骨紧密结合,移植骨增粗、塑造,与受区股骨口径相当。两组患者术后6个月弃拐负重行走,移植骨无折断。结论:带监测皮岛双腓骨或捆绑同种异体骨移植修复股骨缺损,可增加移植腓骨骨量和强度,减少或避免移植腓骨折断。
BACKGROUND： The effect of the treatment of long tubular bone defect by free vascularizcd fibular graft, especially when combined with monitoring island skin flap is definitely reliable. However, there is still the possibility of broken fibular graft with single fibular graft for repairing the long loading tubular bone. OBJECTIVE： To investigate the clinical effect on the treatment of long femoral bone defect by combinatorial fibular graft with monitoring island skin flap. DESIGN： Before and after self-controlled observation. SETTING： Department of Orthopaedic Spine Surgery, Guangzhou People＇s Hospital PARTICIPANTS： Totally 14 patients who wcr treated for long femoral bone defect in the Department of Orthopaedic Spine Surgery were recruited between July 1995 and November 2003. Locus： distal part of the femur, 5cases; middle part of the femur, 9cases.The length of bone defect was 6 to 28 cm. INTERVENTIONS： There were 7 cases of free vascularized bi-fibular graft transplantation with monitoring island skin flap. There were 7 cases of free vascularized fibular graft centralized with large segmental allograft. Monitoring island skin flap was 3 cm×5 cm, sectioned fibular was 16 to 32 cm. Dry frozen bone of allograft was 12 to 28 cm. The wound and island skin were detected postoperatively. MAIN OUTCOME MEASURES： The living condition of bi-fibular graft or binding composite allograft with skin flap, morphology change of transplanted bone and loaded walking ability in patients with bone defect after operation. RESULTS： Totally 14 patients entered the result analysis. Seven cases in bi-fibular group were followed up for 3 years and 7 patients in the centralized graft group were followed up for 1 year. Fourteen cases detected by monitoring island skin flap all survived. One case in the centralized graft group presented yellow exudates 3 months after operation, and then the graft bone was taken out. Follow-up of the rest 6 patients showed that transplanted fibular bone was closely connected with allograf
出处
《中国临床康复》
CSCD
北大核心
2005年第38期170-171,共2页
Chinese Journal of Clinical Rehabilitation
