吻合血管腓骨与异体骨复合移植修复四肢长段骨缺损

REPAIR OF MASSIVE BONE DEFECTS IN LIMBS BY USING VASCULARIZED FREE FIBULAR AUTOGRAFT COMPOUNDING MASSIVE BONE ALLOGRAFTS

目的探讨同期吻合血管的自体腓骨与长段异体骨捆绑或开槽嵌套式复合移植修复四肢长段骨缺损的临床效果. 方法 2001年1月～2003年12月,对19例四肢长段骨缺损患者进行修复.其中男11例,女8例.年龄6～35岁.骨缺损为肱骨1例,股骨9例,胫骨9例.骨缺损长度12～25 cm,平均16.6 cm.采用自体腓骨15～28 cm,平均18.3 cm,其中腓骨干16例,腓骨近段3例,均携带监测皮岛;异体骨11～24 cm,平均16.1 cm.捆绑式复合骨移植3例, 嵌套式16例;单用螺钉固定12例,桥式钢板螺钉内固定7例. 结果所有患者经5～36个月,平均18.2个月随访,供、受区创口均Ⅰ期愈合,监测皮岛成活并与周围组织正常愈合,无明显排斥反应,无供区肢体功能障碍.X线片示术后3个月异体骨与自体骨骨愈合15例,术后8个月愈合3例,另1例左股骨下段滑膜肉瘤术后2个半月局部复发而行截肢.术后超过1年拆除内固定者5例,术中均证实异体骨与自体骨间已骨性愈合,无一例出现异体骨吸收或塌陷. 结论吻合血管的自体腓骨与长段异体骨复合移植修复四肢长段骨缺损,能加速异体骨活化,促进骨愈合,是修复四肢长段骨缺损一种较好的方法,但应严格掌握适应证.

Objective To investigate the clinical effects of repairing massive bone defects in limbs by using vascularized free fibular autograft compounding massive bone allografts. Methods From January 2001 to December 2003, large bone defects in 19 patients （11 men and 8 women, aging from 6 to 35 years） were repaired by vascularized free fibular transplant with a monitoring flap compounding massive deep frozen bone allografts. The length of bone defects were 12 to 25 cm （16.6 cm on average）, of vascularized free fibular 15 to 28 cm （18.3 cm on average）, and of massive bone allografts 11 to 24 cm （16. 1 cm on average）. The location of massive bone defects were humerus in 1 case, femur in 9 cases and tibia in 9 cases. Results After follow-up of 5 to 36 months （18. 2 months on average）, wounds of donor and recipient sites were healed at l stage, monitoring-flaps were alive, no obvious eject reaction of massive bone allografts was observed and no complications occurred {n donor limbs. The radiographic evidence showed union in 15 patients 3 months and 3 patients 8 months after operation. One case of malignant synovioma of left lower femur recurred and amputation was performed 2.5 months after surgery. Internal fixation was removed in 5 patients, and complete bone unions were found 1 year postoperatively. No massive bone allografts was absorbed or collapsed. Conclusion With strict indication, vascularized free fibular autograft compounding massive bone allografts, as an excellent method of repairing massive bone defects in limbs, can not only accelerate bone union but also activate and changer the final resuhs of massive bone allograhs from failure.