吻合血管腓骨移植重建肢体肿瘤切除术后骨缺损

Free vascularized fibular graft for bone reconstruction of the extremities after tumor removed

总结和评价吻合血管胖骨移植术重建肢体肿瘤切除术后骨缺损的疗效，探讨其适应范围．方法：回顾性研究了43例吻合血管肿骨移植重建肢体肿瘤切除术后骨缺损的病例．其中12例恶性骨肿瘤，31例良性肿瘤或瘤样病变．应用插入式微波天线阵列诱导高温原位灭活术28例，侵袭性良性肿瘤应用瘤段切除术7例，良性肿瘤应用刮除术清除病灶8例．移植胖骨长度8cm～25cm，平均15．Icm．所有43例，随访时间超过24mo．分析总结应用此方法的骨愈合时间，临床肢体功能以及术后并发症．结果：一期骨临床愈合时间42例平均为5．lino．根据Enneking保肢重建术后肢体功能评分系统，总体临床结果满意，总平均19O分，上肢功能（23．7分）优于下肢（17．2分）．但发生术后并发症的5例（2例局部复发，2例应力骨折，1例不愈合）需再手术补救，术后功能不满意（9．2分）．结论；吻合血管移植重建骨肿瘤切除术后大块缺损是挽救肢体、保留肢体功能的有效方法，但需注意适应征的选择．

篒M: To summarize and evaluate the results offree vascularized fibular graft (FVFG) for bone reconstruc-tion of extremities after tumor removed in limb-saving proce-dures, and to discuss its extent of application. METHODS:Forty-three patients, with FVFG for bone reconstruction af-ter tumor r6peoved were studied retrospectively, There werel2 cases of malignant bone tumors and 31 benign or tumor-like lesions. FVFG lengths were 8 - 25 cm (mean, 15- lcm). The follow up period of these patients was more thantwo years. Twenty-eight of the lesions were treated with mi-crowave-induced hyperthermia, seven aggressive benign tu-mors were resected and eight benign tumors were curettaged.The time of bone union, functional results of the bone recon-struction and postoperative complications were analyzed. RE-SULTS: The FVFG resulted in substantial bone union in allpatients except one, and the average time of bone union was5. 1 months. According to the Enneking's System of func-tional evaluation of reconstruction after limb salvage, theoverall clinica1 results were satisfactory, the average pointbeing 19. O. The point of functional evaluation in the uppel.extremity was 23. 7 points, which was superior to that (l7- 2points) in the lower extremity. 5 cases with post operativecomplications (2 recurrences, 2 fractures and 1 nonunion )needed reoperation and therefore had the lowest functionalpoint (9. 2 points)- CONCLUSION: The FVFG is effectivein salvaging limb and its function after wide resection of tu-mors in the extremities. However, attention should be paidto the selection of cases.