CAJ | 학술논문

目的探讨下肢长骨大段骨纤维结构不良切除后骨缺损的修复方法.方法 1995年5月至2003年8月,6例骨纤维结构不良患者.男5例,女1例.年龄14～40岁(平均25.5岁).胫骨干2例,股骨干4例.肿瘤切除后骨缺损的长度为15～22 cm.移植双腓骨段长度17～24 cm.均从双侧切取带腓血管的腓骨,在一端将腓血管吻合,使成一条腓血管相连的双段腓骨.将双段腓骨的前内侧骨膜从中央纵行切开并向两侧剥离至骨嵴.双段腓骨折叠,其前内侧面相对,两断端同定,将相对缘游离的骨膜纵行缝合,使其组合为一个骨膜包裹的粗骨.将与双段腓骨相连的腓血管襻在移植体一端制成"U"形,勿形成锐角.能保证血管供血不受影响.解剖出受区血管.将组合的腓骨插入骨折两断端间,如不稳定,加用钢丝或螺钉固定.精确无误地将腓血管与受区血管进行吻合,通过移植体骨膜出血情况判断血管吻合口情况.结果随访6～10年,平均7.4年.1年后骨性愈合;5年后5例移植骨髓腔再通.移植的双腓骨未发生肿瘤,X线片显示为正常骨骼;1例股骨干于正常骨干远段复发,但移植骨部分未复发.骨移植体愈合好,无发生骨不连、骨感染等并发症.膝关节伸屈功能恢复正常,逐渐恢复日常活动与工作.结论骨膜内组合双腓骨移植足修复下肢长骨大段缺损的良好方法 .
목적 탐토하지장골대단골섬유결구불량절제후골결손적수복방법.방법 1995년5월지2003년8월,6례골섬유결구불량환자.남5례,녀1례.년령14～40세(평균25.5세).경골간2례,고골간4례.종류절제후골결손적장도위15～22 cm.이식쌍비골단장도17～24 cm.균종쌍측절취대비혈관적비골,재일단장비혈관문합,사성일조비혈관상련적쌍단비골.장쌍단비골적전내측골막종중앙종행절개병향량측박리지골척.쌍단비골절첩,기전내측면상대,량단단동정,장상대연유리적골막종행봉합,사기조합위일개골막포과적조골.장여쌍단비골상련적비혈관반재이식체일단제성"U"형,물형성예각.능보증혈관공혈불수영향.해부출수구혈관.장조합적비골삽입골절량단단간,여불은정,가용강사혹라정고정.정학무오지장비혈관여수구혈관진행문합,통과이식체골막출혈정황판단혈관문합구정황.결과 수방6～10년,평균7.4년.1년후골성유합;5년후5례이식골수강재통.이식적쌍비골미발생종류,X선편현시위정상골격;1례고골간우정상골간원단복발,단이식골부분미복발.골이식체유합호,무발생골불련、골감염등병발증.슬관절신굴공능회복정상,축점회복일상활동여공작.결론 골막내조합쌍비골이식족수복하지장골대단결손적량호방법 .
Objective To study the methods of repairing bone defects in fibrous dysplasia of lower extremities with two fibula compound transplantation inside periosteum.Methods Six patients with fibrous dysplasia were treated from May 1995 to August 2003.There were 5 males and 1 female with the mean age of 25.5 years (range, 14-40 years).The tumor located at shaft of tibia in 2 patients and shaft of femur in 4 patients.Pathological diagnosis: osteofibrosis dysplasia.The length of the bone defective incomplete was 15 to 22 cm when tumor was ablated.The length of the double fibula for transplant was 17 to 24 cm, which was 2 cm more than the length of the bone defect needing to repair.The anterior-lateral fibular periosteum of the two fibulas were incised vertically, which was stripped to bone ridge.Then folded the two fibula or the two parts of fibula that the anterior-lateral fibula were contacted directly.The opposite sides of periosteum were suture to wrap the double thick fibula, and two end of the fibula were fixed, which was used to repair the bone defects.Results All 6 bone defects were healed.Bone got union after 1 year and cavitas medullaris got recanalization after 5 years.There were not tumor evidences in the transplanting double fibulas, and X-rays confirmed normal ossature.Only 1 patient's tumor relapsed in the distal segment of the normal shaft of femur, but the transplanting double fibular was not involved.The transplant bone accreted well, there was no complication of bone disunion and infection of bone.The articular genu recovered extend -flexion function.The patients could complete daily activities.Conclusion The repair of long and thick bone defects by two fibula compound transplantation inside periosteum is effective.