带监测皮岛的游离腓骨移植治疗尺桡骨萎缩性骨不连

Free Fibular Grafting with Monitoring Flap for Repairing Atrophic Nonunion of Ulna and Radius

目的探讨带监测皮岛的游离腓骨移植治疗尺桡骨萎缩性骨不连的临床疗效。方法回顾性分析2015年6月2018年5月我科应用带监测皮岛的游离腓骨移植治疗尺桡骨萎缩性骨不连20例患者的临床资料,其中尺骨9例,桡骨11例,骨缺损长度3.5~8 cm,平均5.8 cm。监测皮岛切取面积(5.5 cm×4.0 cm)^(13.0 cm×6.5 cm)。术中切除患侧前臂挛缩瘢痕组织,清理骨不连断端,去除萎缩、细小的尺桡骨干。供区为对侧下肢,术前应用多普勒对腓动脉穿支进行定位,根据骨缺损长度及前臂皮肤软组织缺损范围切取带腓动脉及其穿支的复合腓骨组织瓣,并与受区尺桡动脉及伴行静脉吻合。结果本组20例患者均获得随访,随访时间为16~26个月,平均21.3个月。骨移植愈合时间为8~12个月,平均9.9个月。20例监测皮岛均成活,无血管危象发生,皮瓣外形良好,质地、色泽接近受区,无骨断端移位及内固定断裂、松动。供受区伤口均无感染,供区无明显肌力下降及皮肤浅感觉减退。腕关节掌屈、背伸及肘关节屈伸活动度较健侧无明显差异,前臂旋前40°~70°,旋后30°~50°。结论游离腓骨与受区骨匹配程度好,血运可靠,临床骨愈合时间缩短;皮岛可用来监测游离腓骨血运的同时改善前臂软组织条件;尽管手术存在一定风险,仍是治疗尺桡骨萎缩性骨不连的一种理想方法。

Objective To investigate the clinical effect of free fibular grafting with monitoring flap for repairing atrophic nonunion of ulna and radius.Methods The clinical data of 20 cases with atrophic nonunion of ulna and radius fractures treated by free fibular grafting with monitoring flap were analyzed retrospectively,including 9 cases with ulna atrophic nonunion and 11 cases with radius atrophic nonunion.The range of bone defect was 3.5 to 8 cm in length with an average of 5.8 cm.The size of monitoring flaps ranged from 5.5 cm×4.0 cm to 13.0 cm×6.5 cm.All the patients were in supine position,scar tissue of involved limb was ablated,nonunion ends were cleaned,atrophic and small radius and ulna were removed.The donor site was located on the contralateral lower extremity,preoperative localization of peroneal artery perforators by Doppler flow imaging was applied,composite fibular tissue flaps with peroneal artery and perforator were harvested according to the length of bone defect and the extent of forearm skin tissue defect,and were carried out the anastomosis with ulnar-radial artery and accompanying veins in recipient area.Results All 20 patients were followed-up for 16 to 26 months with an average of 21.3 months.The healing time of bone graft was 8 to 12 months with an average of 9.9 months.All the flaps survived without vascular crisis.The appearance of flap was good and slight bloated,and the texture and color of the flap was close to the recipient site.There was no broken bone displacement and internal fixation broking or loosening.There was no infection in donor site and recipient site.The donor site had no significantly dysfunction due to the declining of muscle strength and superficial skin sensation.The wrist and elbow joint motion were almost as same as the healthy side with the range of 40°to 70°of pronation and 30°to 50°of supination.Conclusions The grafting of free fibular with monitoring flap has good bone matching and reliable blood supply,which can shorten the bone healing time.The skin island can monitor the blood flow of free fibular and improve the soft tissue conditions.Despite the operation risk,free fibular grafting with monitoring flap is an ideal technique to repair atrophic nonunion of ulna and radius.