带血管腓骨移植并一期胫骨延长治疗先天性胫骨假关节(附3例报告)

Treatment of congenital pseudarthrosis of tibia with vascularized fibula transplantation combined with tibial lengthening simultaneously:a report of 3 cases

目的观察带血管腓骨移植并一期胫骨延长治疗先天性胫骨假关节近期临床效果。方法手术中彻底切除病变软组织和病变的胫骨,切取带血管腓骨游离移植2例,另1例采用同侧带血管蒂腓骨转移,将腓骨两端分别插入胫骨近侧和远侧段髓腔,游离腓骨移植将腓动脉和胫前动脉吻合。胫骨延长位于近侧端2例,胫骨远侧端延长1例,使用半环型可延长外固定支架,每天延长1mm。结果3例患者手术顺利,手术后4个月移植腓骨与胫骨愈合,胫骨延长区2周可见骨生长,4个月时骨质浓密,无神经血管并发症发生。结论带血管腓骨移植并一期胫骨延长是治疗胫骨假关节的有效方法。

Objective To observe the short-term clinical effect of congenital pseudartthrosis of tibia treated by vascularized fibula transplantation combined with tibial lengthening simultaneously. Method During the operation, the pathologic soft tissues and bone were thoroughly reseeted, 2 patients were transplanted with dissociated vascularized fibula, and another treated by vascularized ispilatere fibular graft. Two end of the fibula were separately inserted in the medullary cavity of the proximal tibia and distal tibia. To the dissociated vascularized fibula, the fibular artery was anastomosed with the anterior tibial artery; in two patients lengthen on the proximal tibia, and in another on the distal tibia. Semicircular external fixators were used for gradual tibial lengthening, lmm everyday. Result All of the three operations were all right, the transplanted fibula healed with tibia later 4 months after operation. Ostosis could be seen on the place of tibial lengthening later two weeks after operation, osseous thickening later 4 months＇ after operation. Complications of nerve and blood vessel had not occured. Conclusion Vascularized fibula transplantation combined with tibial lengthening simultaneously is an effective and satisfactory method for the treatment of pseudarthrosis of tibia.