血管化腓骨移植(VFG)在四肢骨缺损重建中的临床应用评价

Clinical Evaluation of Vascularized Fibular Graft (VFG) in the Reconstruction of Limb Bone Defects

目的:探讨血管化腓骨移植(VFG)在四肢骨缺损重建中的临床疗效。方法:自2013年1月~2022年12月期间31例四肢骨缺损患者行血管化腓骨移植术。其中男22名(70.96%),年龄(35.64 ± 17.01)岁。术前骨缺损长度(8.45 ± 3.96) cm,血管化腓骨移植长度(10.79 ± 3.99) cm。术后随访时间超12个月记录骨愈合状态,末次随访记录肢体长度差异(双上、下肢长度),患肢功能评分(上肢ARAT评分、BBT评分,下肢AOFAS足后踝评分量表、LEFS下肢功能评分),腓骨肥大率与再骨折。结果:31例患者平均随访时间(26.45 ± 11.06)月。96.78%患者得到初期骨性愈合。双上肢长度差异(1.31 ± 1.18) cm、双下肢长度差异(1.97 ± 2.10) cm。上肢ARAT评分(34.29 ± 8.38)分、BBT评分(27.00 ± 13.96)分,下肢AOFAS评分(78.33 ± 11.00)分、LEFS评分(35.42 ± 19.41)分。腓骨肥大率(12.45 ± 8.34)%,2 (6.45%)例再骨折。结论:血管化腓骨移植治疗四肢大段骨缺损可取得良好疗效,可一期快速补充大量骨质,但术后仍存在肢体长度差异及肢体功能受限。可做为一期移植缩短治疗时长,择期决定是否行肢体延长矫正。

Objective: To investigate the clinical efficacy of vascularized fibular grafting (VFG) in the reconstruction of limb bone defects. Methods: From January 2013 to December 2022, 31 patients with limb bone defects underwent vascularized fibular grafting. Among them, 22 were male (70.96%) with an average age of (35.64 ± 17.01) years. The preoperative bone defect length was (8.45 ± 3.96) cm, and the length of vascularized fibular grafting was (10.79 ± 3.99) cm. The bone healing status was recorded after a follow-up period of more than 12 months, and the final follow-up included recording the limb length discrepancy (difference in length between upper and lower limbs), functional scores of the affected limb (upper limb ARAT score, BBT score, lower limb AOFAS ankle-hindfoot score, LEFS lower limb function score), fibular hypertrophy rate, and re-fracture rate. Results: The average follow-up time for the 31 patients was (26.45 ± 11.06) months. 96.78% of patients achieved initial bony union. The discrepancy in length between the upper limbs was (1.31 ± 1.18) cm, and between the lower limbs was (1.97 ± 2.10) cm. The upper limb ARAT score was (34.29 ± 8.38), BBT score was (27.00 ± 13.96), lower limb AOFAS score was (78.33 ± 11.00), and LEFS score was (35.42 ± 19.41). The fibular hypertrophy rate was (12.45 ± 8.34)%, with 2 cases (6.45%) of re-fracture. Conclusion: Vascularized fibular grafting is effective in the treatment of large segment bone defects in limbs, allowing for rapid supplementation of bone mass in a single stage. However, limb length discrepancy and functional limitations may still exist postoperatively. It can be used to shorten the treatment duration in one stage, with the option to decide on limb lengthening correction at a later date.