带血管蒂腓骨移植加锁定钢板内固定术治疗肱骨术后大段骨缺损

Vascularized Fibula Grafting plus Locking Plate Internal Fixation for Large Segmental Bone Defects of Humerus

目的探讨带血管蒂腓骨移植加锁定钢板内固定术治疗肱骨干术后大段骨缺损的疗效。方法回顾性分析2010年1月-2014年1月间在我院采用带血管蒂腓骨移植加锁定钢板内固定术治疗肱骨术后大段骨缺损7例患者的临床资料。骨缺损长度平均8.8（6-10）cm。结果本组患者术后随访6-24个月,带皮瓣腓骨移植者皮瓣全部成活。X线片示移植腓骨无吸收、硬化及破坏等征象,骨折线模糊消失,骨端骨性愈合,愈合时间平均4.1（2-6）个月。3例移植腓骨已较前增粗。术后6个月肩关节Neer评分及肘关节Mayo评分均较术前明显改善,差异有统计学意义（P〈0.05）。结论带血管蒂腓骨移植加锁定钢板内固定术治疗肱骨术后大段骨缺损,可达到良好临床效果,但该术式要求术者有较高的手术技巧,同时牺牲一侧腓骨,因此仍需要积累更多的病例及进行更长期的随访以观察远期效果。

Objective To investigate the effect of vascularized fibula grafting plus internal fixation of locking plate for treatment of large bone defects of humerus. Methods The clinical data of 7 cases with large segment bone defect of the humerus from January 2010 to January 2014 in our hospital were analyzed retrospectively. The length of bone defect was 6 to 10 cm with an average of 8. 8 cm. Results All cases were followed up for 6 to 24 months,and all the skin flaps and fibula flap were survived. The X-ray showed no absorption,hardening and destruction of the grafting fibula was found,and the fracture lines disappeared and the bone was healed during 2 to 6 months after the surgery,with an average of 4. 1 months. 3 cases of the fibula had been enlarged. Both the Neer score of shoulder joint function and the Mayo score of elbow joint function after the surgery were significantly better than those before the surgery,the difference was statistically significant（ P〈0. 05）.Conclusion The surgery of vascularized fibula transplantation plus internal fixation of locking plate can achieve an ideal clinical effect for large segment humerus bone defect based on skilled surgical operating and sacrifice of unilateral fibula,so larger specimen and longer follow-up is necessary to further research.