以隐血管为蒂的逆行股骨内侧髁骨瓣骨皮瓣的解剖学研究及临床应用

ANATOMICAL STUDY AND CLINICAL APPLICATION OF MEDIAL FEMORAL CONDYLAR BONE FLAP PEDICLED WITH THE SAPHENOUS VESSELS

目的 为治疗胫骨骨不连和骨缺损提供一种新方法。方法 通过解剖学观察膝降动脉关节支及隐支的关系 ,并摹拟手术证实以隐血管为蒂的逆行股骨内侧髁骨瓣的切取可能。结果 尸体摹拟手术 4例 ,切取后关节支均有墨汁显示。临床应用 2例 ,切取骨瓣分别为 5 .0 cm× 2 .0 cm× 1.5 cm及 4.5 cm× 1.5 cm× 1.5 cm均有活跃渗血。随访 8～ 12周 ,骨折愈合良好。结论 应用以隐血管为蒂的逆行股骨内侧髁骨瓣骨皮瓣治疗胫骨骨不连和骨缺损具有手术方法简便 ,疗效可靠 ,易于推广等优点。

Objective To investigate a new operative method for repairing nonunion and defect of tibia. Methods First, observe the relation between the joint branches of descending genicular artery and the saphenous branch of descending genicular artery in 10 cadevers. Then the medial femoral condylar bone flap pedicled with the saphenous vessels was prepared in 4 cadavers for simulated purpose. Clinically, two patients with tibial nonunion were treated by transplantation of this pedicled bone flap. Results In the 4 simulated operations, the ink which was injected into the femoral artery could be released from the joint branches. And in the clinical operation, the area of the pedicled bone flaps were 5.0 cm×2.0 cm×1.5 cm and 4.5 cm×1.5 cm×1.5 cm respectively. Followed up for 8 to 12 weeks, the fracture unioned well. Conclusion This operation is simple and reliable, it is characterised by ① unnecessary to anastomosis the vessels ② reliable blood supply ③high quality of bone flap ④ either bone flap or bone skin flap can be chosen ⑤ long vessel pedicle.