游离自体腓骨修复胫骨骨与纤维结构不良病灶切除后的骨缺损

To use the autogenous dissociative fibula rehabilitate the defect of tibia bone for the postoperative residual absence of osteofibrous dysplasia

目的评介游离自体腓骨修复胫骨骨与纤维结构不良病灶切除后的骨缺损的疗效。方法以胫骨病灶部位为中心,C型臂透视下确定切除范围,一般上下端远离病灶上下缘至少1cm,以电钻在切除段上下钻数个孔,开槽,电动摆锯沿肿瘤基底部约1.0cm处水平切除大段病灶骨,后方保留不少于1/3胫骨骨质,沿腓骨纵向切开腓骨骨膜,在腓骨中段,用线锯切取与测量的切断的胫骨等长的腓骨,腓骨骨膜袖状原位缝合。将切取的腓骨纵向劈开为两块,皮质骨向外,用“10”号丝线或钢丝缚扎在胫骨缺损处,胫骨骨膜缝合包裹移植腓骨。将这种游离的自体腓骨移植方法与人工假体、同种异体骨、自体髂骨、肩胛骨以及吻合血管的自体腓骨移植进行比较。结果全部病例随访2-4年,仅1例出现移植腓骨的上端复发。所有移植腓骨X线片呈现理想的替代形态。术后3个月移植腓骨与受体骨发生骨性愈合,部分腓骨有不同程度的增粗。所有患儿膝关节及踝关节活动正常,足趾伸屈活动正常,双侧小腿长短及粗细相等,步态正常,无畸形,无肌力改变。结论游离自体腓骨修复胫骨骨与纤维结构不良病灶切除后的骨缺损,是一种比较好的措施和方法,较其他治疗方法比较,它保留了腓骨骨膜,使切除腓骨后保留的腓骨骨膜再次成骨,腓骨原来的解剖结构重新获得,游离移植的腓骨与受体骨的愈合质量、速度并不比吻合血管的腓骨移植差,且手术简单,损伤小,技术要求不高。

Objective To estimate the treatment of repairing the postoperative residual absence of osteofibrous dysplasia of tibia with autogeneous fibula graft in comparison with peosthesis, auto -ilium or scapular graft, and auto -fibula transplantation with anastomosed vascularization. Methods We had treated 7 inpatients of osteofibrous dysplasia （2 males,5 females） aged 10- 16 years old,who had all underwent surgical operation with pneumatic tourniquet. As following ：we extendedly resected the tibia lesion according to the C -arm fluoroscopy＇s localization, resected the same length of ipsilateral middle fibula beneath periosteum subsequently finaly fastened tibia and the resected fibula which were splited into half. In postoperation, patients could protect the suffered extremity with orthosises which could make the ankyle joint free. Results All cases were followed up 2 -4 years, showing uniform length,thickness, symmetrical gait and joint activity compared with contralateral extremity except a recurrence in the proximal grafted fibula, and The X - ray plain films represented the favorable remodelization, grafted fibula healed up with the tibula acceptor 3 months postoperative. Some grafts shew thicker at diverse extent. The donors had created new fibula with periosteum after 3 month,which remodeled completely after 6 months and medullarized after 14 months. Fractures angular deformity haven＇t occurred. Conclusions In light of our acquirement,it is a comparative recommended treatment that repaires the postoperative residual absence of osteofibrous dysplasia of tibia with autogeneous fibula graft as result of less lesion, simpier technique and higher healing of rapidity and quality. Additionally, the treatment preserves the periosteum in order to accelerate osteogenesis and reconstruction of fibula.