带监测皮瓣的游离腓骨瓣移植治疗尺骨骨缺损疗效分析

Clinical analysis of free fibula flap with monitoring flap for ulna defect

目的探讨带监测皮瓣的游离腓骨皮瓣修复尺骨骨缺损的临床效果。方法回顾性分析2017年6月—2020年6月收治的11例尺骨干骨缺损患者临床资料。其中,男性8例,女性3例。年龄35~52岁,平均(42.3±2.3)岁。左侧尺骨4例,右侧尺骨7例,其中开放性粉碎性骨折2例,闭合性粉碎性骨折9例。致伤原因:机器碾压伤4例,矿井重物砸伤6例,车祸伤1例。纳入研究患者均为单纯尺骨骨缺损,无合并皮肤软组织缺损,且无合并前臂其他部位骨折,入院时生命体征稳定。尺骨缺损长度3.1~4.4 cm,平均3.7 cm。排除手术禁忌症后二期行带监测皮瓣的游离腓骨瓣移植修复尺骨骨缺损。结果术后11例患者均得到随访,随访时间为6~18个月。移植腓骨及监测皮瓣均成活,治疗期间供区及受区伤口均无感染表现,且Ⅰ期愈合。术后3个月X线检查11例患者均可见骨痂生长,6个月后7例患者骨折线模糊,复查14个月后11例患者骨移植处均得到愈合。末次随访功能评价:优6例,良3例,差2例,优良率81.8%。患者对侧健肢优良率100%。Enneking系统评分:11~15分2例,16~20分1例,21~25分3例,26~30分6例,平均(22.54±5.22)分,与健侧对比有统计学差异(t=2.472,P=0.023)。排除因康复原因造成的前臂功能障碍病例,本组患者患侧与健侧功能评分对比无统计学差异(t=1.800,P=0.091)。结论在早期康复治疗干预下,带监测皮瓣的游离腓骨瓣可良好修复尺骨骨缺损,值得进行临床推广。

Objective To investigate the clinical effect of free fibula flap with monitoring flap in repairing ulna bone defect.Methods The clinical data of 11 patients with ulna shaft defect admitted from June 2017 to June 2020 were retrospectively analyzed.Among them,8 were males and 3 were females.The age ranged from 35 to 52 years old,with an average of(42.3±2.3)years old.There were 4 cases of left ulna and 7 cases of right ulna,including 2 cases of open comminuted fractures and 9 cases of closed comminuted fractures.Causes of injury:4 cases were injured by machine crushing,6 cases were injured by heavy objects in mines,and 1 case was injured by car accident.All patients included in the study had simple ulnar bone defects,no skin and soft tissue defects,and no other forearm fractures,and their vital signs were stable on admission.The length of the ulnar defect was 3.1~4.4 cm,with an average of 3.7 cm.After excluding surgical contraindications,free fibular flaps with monitoring flaps were transplanted to repair ulnar bone defects in the second stage.Results All the 11 patients were followed up for 6-18 months.The fibula grafts and monitored skin flaps were all survived.During the treatment,there was no infection in the donor and recipient wounds,and the wound healed atⅠstage.X-ray examination 3 months after surgery showed callus growth in 11 patients;6 months later,fracture lines were blurred in 7 patients;reexamination 14 months later,bone grafts in 11 patients were healed.Function evaluation in the last follow-up:6 cases were excellent,3 cases were good and 2 cases were poor,with an excellent and good rate of 81.8%.The excellent and good rate of contralateral limb was 100%.Enneking system score:2 patients scored 11-15,1 patient scored 16-20,3 patients scored 21-25,and 6 patients scored 26-30,with an average of(22.54±5.22)points,which was statistically different from that of the healthy side(t=2.472,P=0.023).Excluding cases of forearm dysfunction caused by rehabilitation reasons,there was no statistical difference in functional scores between the affected side and the healthy side in this group of patients(t=1.800,P=0.091).Conclusion Free fibular flap with monitoring skin flap can repair ulna defect well under early rehabilitation treatment intervention,and it is worthy of clinical promotion.