摘要
目的介绍应用带血管蒂游离腓骨瓣移植修复尺骨骨缺损。方法切取带有腓血管供血的腓骨上3/4段修复尺骨骨缺损13例,对其中4例伴有皮肤缺损者,采用腓骨骨皮瓣联合修复；腓骨移植长度为6～16cm；腓骨骨皮瓣面积为15cm×8cm～25cm×12cm。术后分别于1、3、6、12个月对前臂拍摄X线片,术后12个月测定患肢功能。结果13例9块腓骨瓣、4块腓骨骨皮瓣全部成活。术后11例获得1年以上的随访,腓骨瓣与尺骨完全骨性愈合时间为4～6个月。前臂旋转功能：优2例,良6例,差3例,优良率为72．7％。按Enneking系统评分：平均为21分,平均恢复了肢体功能的70％。供骨区踝关节活动正常,腓总神经支配区感觉无异常。结论应用带血管蒂游离腓骨瓣修复尺骨骨缺损,方法可靠,既保持了尺骨长度,又为骨折愈合提供了血供,是一种治疗骨缺损的理想手术方法。
Objective To introduce the application of flee fibular transfer for reconstruction large defect of the ulna. Methods The upper 3/4 of the fibula nurtured by the peroneal artery was harvested as vascularized bone graft to reconstruct defect of the ulna in 13 cases. A skin island was taken with the vascularized fibular bone to form a osteocutanecus flap in 4 cases with soft tissue loss. The length of harvested fibula ranged from 6cm to 16cm. The area of the skin flaps ranged from 15cm ×8cm to 25cm × 12cm. Postoperatively X-ray of the forearm was taken at 1 month, 3 months, 6 months, and 12 months intervals. Upper limb function was evaluated 1 year following the surgery. Results Postoperative follow-up ranged from 4 months to 24 months, with 11 cases followed for over 1 year. All transplants including both bone and skin flaps survived completely. The reconstructed ulna achieved bone union 4-6 weeks postoperatively with good alignment. Forearm rotation was graded as good in 2 cases, fair in 6 cases, and poor in 3 cases. The overall satisfactory rate was 72.7%. The average Enneking score was 21. Upper limb function recovered to 70% of that of the normal side. There was no morbidity of the donor lower limb. Ankle movement was normal. The sensory territory of the common peroneal nerve retained normal sensation. Conclusion Free fibular transfer can be applied to repair defects of the ulna. The operation not only can keep the length of the ulna but also can nurture the fracture site from the peroneal artery. Due to its constant vascular anatomy and technical ease of harvest, this flap is a reliable and optional choice for the management of this type of injury.
出处
《中华手外科杂志》
CSCD
北大核心
2006年第4期229-231,共3页
Chinese Journal of Hand Surgery
关键词
组织移植
显微外科手术
尺骨缺损
游离腓骨瓣
Tissue transplantation
Microsurgery
Ulna injuries
Free fibular flaps
