同侧带蒂腓骨转移治疗创伤性胫骨骨髓炎、骨缺损

Ipsilateral pedicle vascularized fibula transportation for the treatmemt of traumatic osteomyelitis complicated with bone defect in tibia

目的 应用同侧带蒂腓骨转移的方法治疗创伤性胫骨骨髓炎、骨缺损,并观察其疗效.方法 采用同侧带蒂腓骨转移的方法治疗6例创伤性胫骨慢性骨髓炎、骨缺损的病例,男5例,女1例,年龄28～52岁,平均40岁,胫骨缺损范围为5 ~8 cm,平均6.1 cm,所有患者术前检查均显示患肢软组织及血管条件欠佳.结果 患者均获随访,随访时间6～51个月,平均29.5个月.所有患者均达到骨愈合,愈合时间4～10个月,平均5个月.转移腓骨愈合后均明显增粗,接近胫骨水平.术后Enneking功能评分17～27分,平均22分.无骨髓炎复发及再骨折发生,没有患者出现关节僵硬、踝关节不稳等并发症,亦无神经损伤和内固定松动断裂发生.结论 同侧带蒂腓骨转移治疗软组织和血管条件较差的胫骨骨缺损,是一种简单且效果良好的治疗方案.

Objective To study the effect of the application of ipsilateral pedicle vascularized fibula transportation in treatment of traumatic osteomyelitis complicated with bone defect in tibia.Methods 6 cases of traumatic osteomyelitis complicated with bone defect in tibia were treated with ipsilateral pedicle vascularized fibula transportation. There were 5 males and 1 females with the mean age of 40 （range,28 to 52） years. The mean range of the bone defect was 6.1 （range 5 to 8）cm. The Preoperative examination shows poor soft tisse condition and avascular bed in all of these cases.Results All patients were follow-up 6 to 51 months,with the mean period of 29.5 months. The fibula grafts were all healed and got thickened obviously. The mean healing period was 5 （range 4 to 10） months. The mean functional score based on Enneking system was 22 （range 17 to 27）. There is no osteomyelitis recurrence or refracture. None of the patients suffurred from stiffness of joint or ankle instability. And there is no nerve injury or failure of fixation being ovserved during the follow-up.Conclution As the soft tissue and vascular condition is always poor after high energy open fractures,ipsilateral pedicle vascularized fibula transportation should be a easy and good choice for the treatment of traumatic osteomyelitis complicated with bone defect in tibia.