带血管骨移植治疗骨折萎缩性不愈合

Treatment of atrophic non-union after fracture with vascular bone graft

[目的]骨折断端缺乏血运可造成骨折萎缩性不愈合,通过吻合血管的腓骨、髂骨移植使骨折断端获得血运,从而达到骨性愈合。[方法]将骨不愈合端的萎缩骨、硬化骨切除,钻通髓腔,根据骨缺损的长短,切取相应带腓血管的腓骨,带旋髂深血管的髂骨移植到骨缺损处,采用钢板或单纯螺丝钉固定骨折,然后将带骨的血管蒂与受区血管吻合,恢复腓骨和髂骨的血运,术后辅以石膏外固定。[结果]25例骨折萎缩性不愈合随访8个月～3a,全部骨折愈合。其中19例3个月,5例4个月,1例6个月达骨性愈合。[结论]吻合血管的骨移植可使骨断端重新获得血运,将陈旧性骨折变成类似新鲜的骨折,骨折愈合过程不经过“爬行替代”,是治疗骨折萎缩性不愈合的理想选择。

[ Objective] Blood supply deficiency of the fractured bone ends resulted in atrophic non-union. Bone graft with vascular anastomosis was investigated to provide these ends with necessary blood supply. [Methods] Atrophic and sclerosis bones with the non-union ends were resected. According to the length of bone defect, fibulae or ilia with vessel pedicle were transplanted to the fractured sites and anastomosed with the correspond blood vessels there, external fixation of plaster was used after operation. [ Result] Twenty-five cases of atrophic non-union were followed up from 8 month to 3 years. All fractures knitted in the following time： 19 cases in 3 months, 5 in 4 months, and 1 in 1 month. [Conclusion] Bqne graft with vascular anastomosis helps the fracture site obtain blood supply again, it is an optimal therapeutic prografmme for cases of atrophic non-union after fracture.