下肢长骨大段骨纤维结构不良切除后骨缺损修复方法探讨

Explore the method of repairing bone defect after resection of lower extremity long bone structure fiber

目的：探讨下肢长骨大段骨纤维结构不良导致大段骨缺损的修复方法，为临床治疗提供参考。方法6例骨纤维结构不良患者（胫骨损伤3例，股骨损伤3例），肿瘤切除后骨缺损长度（17．3＆#177;4．2）cm，均从双侧切取带腓血管腓骨于缺损另一端同腓血管吻合。双段腓骨前内侧骨膜从中央纵行切开剥离至骨嵴，将腓骨双段折叠后使其前内侧面相对，两端固定。将腓血管襻在移植体一侧形成U形。解剖出损伤区血管，将腓骨插入骨折两断端间，视情况加用钢丝或螺钉，使腓血管同损伤区血管吻合。术后对骨结合部愈合情况进行影像学评估，并采用美国骨肿瘤学会功能评分对术后功能进行评估，通过移植体出血情况检测血管吻合情况。结果所有患者随访5～8年，1年后均骨性愈合，5年后移植骨髓腔再通，双腓骨未发生肿瘤，X线显示愈合良好，均为正常骨骼，未发生骨不连、感染等并发症。终末随访下肢评分平均91．2分。结论骨膜内组合双腓骨修复骨纤维结构不良致下肢长骨大段缺损有效可行。

Objective To analyze the repair methods of bone defects caused by the harmful removal of lower extremity long bone segmental bone fibrous structure,and to provide reference for clinical treatment.Methods Six cases of patient with adverse fibrous structure,3 cases with the jnjury of backbone of the tibia and 3 cases of femoralshaft damage were conducted as the research objects.Bone defect length after tumor resection was （17.3±4.2）cm,inorder to coinside with the peroneal vessels in the other side,fibulas with peroneal vessels from both sides should be cutdown.Dual fibula medial periosteal was stripped from the central longitudinal incision to the bone crest,folding fibulatwo -stage to make the front sides face to face,and then fixed the ends.The peroneal vascular was looped on one sideof graft to form a U shape.The vessels out of damage region was dissected,and was inserted fibula between the ends offracture,as the case wire or screws may be used.The peroneal vessels had to coinside with those in damage region,andimaging assessment should be taken to evaluate the healing of bone joints after surgery,at the same time,assessingpostoperative function by functional scores of Bone Cancer Society of the United States was also neccessary,finallyvascular anastomosis through the bleeding condition of the grafts were detected.Results All patients were followedup for 5 -8 years,the bone healed 1 year later,and the transplanted bone marrow cavity got recanalization 5 years later,at the same time,there was no tumorigenesis in the double fibula,and x -ray showed the good healing.All bonesturned to be normal ones without nonunion,infection and other complications.Final follow -up score of lower limbswas 91.2%.Conclusion It is effective and feasible to use a combination of double fibula to repair lower extremitylong bone defects caused by large bone fibrous dysplasia in the periosteum.