带血供腓骨移植Ⅰ期修复小儿慢性骨髓炎死骨缺损

One stage fibular pedicle graft in the treatment of chronic osteomyelitis in children

目的 探索小儿慢性骨髓炎大段死骨早期摘除后骨缺损的Ⅰ期修复效果。方法 16例胫骨慢性骨髓炎并大段死骨清除后 ,作吻合血管腓骨移植Ⅰ期重建 ;2例作炎性骨段切除 ,采用带血管蒂腓骨移位Ⅰ期修复。结果 18例胫骨慢性骨髓炎在摘除大段死骨后 ,应用吻合血管腓骨移植或带血管蒂腓骨移植重建。术后平均随访 2 6个月 ,见重建骨完全骨性愈合 ,累及的炎症得到完全控制 ;修复肢体的功能、外形令人满意。结论 慢性骨髓炎所形成的大段死骨在作病灶清除的同时 ,进行早期的血管吻合或带血管腓骨移植Ⅰ期重建术 ,可免除死骨爬行替代的漫长病程 ,改善受区血液循环 ,抑制炎症漫延 ,缩短了住院时间 ,减少手术次数。

Objective To evaluate the efficacy of fibular pedicle grafts in the management of chronic osteomyelitis in children.Methods Eighteen patients with tibial defects, including 16 of chronic osteomyelitis with large sequestrum and 2 cases of bone debridement underwent one stage fibular pedicle graft.Results The follow up,averaging 26 months,showed good bone union in all cases.The infection was under control.The limb function and contour were satisfactory.Conclusion Early excision of sequestrum in chronic osteomyelitis and simultaneous reconstruction with fibular pedicle graft shortens hospitalization,improves circulation and avoids recurrence.