腓骨移植治疗肢体侵袭性骨肿瘤和恶性骨肿瘤

FIBULA GRAFTING FOR THE TREATMENT OF AGGRESSIVE BENIGN AND MALIGNANT BONE TUMOR OF EXTREMITY

目的：比较游离腓骨或吻合血管腓骨移植治疗切除四肢侵袭性骨肿瘤或恶性骨肿瘤后引起的长段骨缺损的临床疗效。方法：对１８例吻合血管移植及４例游离腓骨移植术的病例术后，采用ＥＣＴ、彩色多普勒血管超声检查、Ｘ线照片检查及随访，时间为术后２～１２年，移植骨最长达２６ｃｍ。结果：侵袭性骨肿瘤和恶性骨肿瘤１８例，肿瘤切除后用吻合血管腓骨移植重建缺损，１５例桡骨远端骨巨细胞瘤患者作游离腓骨移植重建缺损，结果前者愈合良好，移植骨片与受骨接合牢固，游离腓骨移植则愈合较差。结论：吻合血管腓骨移植可一期重建因骨肿瘤或骨恶性肿瘤广泛切除后造成的６ｃｍ以上的骨缺损，其优越性远远超过游离腓骨移植。

Objective:To compare the effect of vascularized and non-vascularized fibula grafting performed for the reconstruction of bone defect after the resection of bone tumor.Methods:Vascularized fibula grafting was performed in 18 patients with malignant or aggressive benign bone tumors of the extremity,meanwhile non-vascularized fibula grafting was performed in 15 patients with giant cell tumors of the radius.All the 33 patients were followed up by radiography,SPECT,CDS examinations and functional observation for 2 to 12 years,Results:Vascularized fibula grafts showed good blood supply in ECT and radiography examinations and bone union was achieved,the length of bone defect ranged from 9 to 26 cm.In non-vascularized fibula grafting cases,bone union was not achieved.Conclusions:The advantages of vascularized grafting was the feasibility of stage I reconstruction of various tissues and growth of grafted fibula.It is necessary to adopt vascularized fibula grafting to reconstruct large bone defect resulting from the resection of extensive bone tumors such as GCT,fibrous dysplasia of bone and malignant bone tumor.