中华显微外科杂志
中華顯微外科雜誌
중화현미외과잡지
Chinese Journal of Microsurgery
2015年
2期
134-137
,共4页
腓骨移植%股骨%感染%骨缺损%显微外科技术
腓骨移植%股骨%感染%骨缺損%顯微外科技術
비골이식%고골%감염%골결손%현미외과기술
Fibular graft%Femur%Infection%Bone defect%Microsurgical technique
目的 探讨应用游离腓骨移植治疗股骨感染性骨缺损的临床应用及效果. 方法 2008年4月-2013年4月,对9例股骨感染性骨缺损病例进行游离腓骨移植手术,术前窦道分泌物及术中病灶处细菌培养均证实感染.经清创后骨缺损长度(7.5±2.4)cm,其中一期手术6例,待感染控制后二期行游离腓骨移植3例.3例采用单根腓骨移植修复,6例采用双折腓骨移植修复.6例腓骨瓣携带皮瓣来监测移植腓骨血运.术中采用钢板固定移植腓骨6例,采用外固定支架固定3例.术后对移植腓骨的成活与骨结合部愈合情况进行影像学评估,应用Enneking下肢功能评分评价术后功能. 结果 全部移植腓骨均成活并获得骨性连接.全部病例随访12 ～ 39个月,平均24.5个月.移植腓骨长度平均(14.5±3.2)cm.移植骨和股骨的平均愈合时间为(5.5±1.2)个月.终末随访时Enneking下肢功能评分20 ～ 27分,平均24分,供区无功能障碍,无感染复发,移植腓骨无应力骨折发生. 结论 游离腓骨移植治疗股骨感染性骨缺损有利于治疗感染,骨愈合率高,是理想的治疗方法.
目的 探討應用遊離腓骨移植治療股骨感染性骨缺損的臨床應用及效果. 方法 2008年4月-2013年4月,對9例股骨感染性骨缺損病例進行遊離腓骨移植手術,術前竇道分泌物及術中病竈處細菌培養均證實感染.經清創後骨缺損長度(7.5±2.4)cm,其中一期手術6例,待感染控製後二期行遊離腓骨移植3例.3例採用單根腓骨移植脩複,6例採用雙摺腓骨移植脩複.6例腓骨瓣攜帶皮瓣來鑑測移植腓骨血運.術中採用鋼闆固定移植腓骨6例,採用外固定支架固定3例.術後對移植腓骨的成活與骨結閤部愈閤情況進行影像學評估,應用Enneking下肢功能評分評價術後功能. 結果 全部移植腓骨均成活併穫得骨性連接.全部病例隨訪12 ～ 39箇月,平均24.5箇月.移植腓骨長度平均(14.5±3.2)cm.移植骨和股骨的平均愈閤時間為(5.5±1.2)箇月.終末隨訪時Enneking下肢功能評分20 ～ 27分,平均24分,供區無功能障礙,無感染複髮,移植腓骨無應力骨摺髮生. 結論 遊離腓骨移植治療股骨感染性骨缺損有利于治療感染,骨愈閤率高,是理想的治療方法.
목적 탐토응용유리비골이식치료고골감염성골결손적림상응용급효과. 방법 2008년4월-2013년4월,대9례고골감염성골결손병례진행유리비골이식수술,술전두도분비물급술중병조처세균배양균증실감염.경청창후골결손장도(7.5±2.4)cm,기중일기수술6례,대감염공제후이기행유리비골이식3례.3례채용단근비골이식수복,6례채용쌍절비골이식수복.6례비골판휴대피판래감측이식비골혈운.술중채용강판고정이식비골6례,채용외고정지가고정3례.술후대이식비골적성활여골결합부유합정황진행영상학평고,응용Enneking하지공능평분평개술후공능. 결과 전부이식비골균성활병획득골성련접.전부병례수방12 ～ 39개월,평균24.5개월.이식비골장도평균(14.5±3.2)cm.이식골화고골적평균유합시간위(5.5±1.2)개월.종말수방시Enneking하지공능평분20 ～ 27분,평균24분,공구무공능장애,무감염복발,이식비골무응력골절발생. 결론 유리비골이식치료고골감염성골결손유리우치료감염,골유합솔고,시이상적치료방법.
Objective To investigate the clinical application and effect of repair infectious bone defect in femur with free vascularized fibular graft.Methods From April,2008 to April,2013,9 patients that had infectious bone defect in femur underwent repaired with free vascularized fibular graft.The bacterier cultivation of sinus tract excretion in preoperation and focal zone in operation had proved the infection.The length of bone defect were7.5 cm on average.The bone defect was repaired with free vascularized fibular graft on one stage in 6 cases and two stages in 3 cases after the cure of infection.Six patients underwent folded and 3 patients underwent single vascularised fibula graft transfer.The skin island flaps were used as a postoperative predictor of vascularized fibula graft viability in 6 cases.The transfer fibulars were fixed with plate in 6 cases,external fixor in 3 cases.Time to union was recorded through evaluation of plain radiographs.The Enneking score system was applied to evaluate the lower extremity function.Results The vascularized fibular survived and bony fusion was achieved in all patients.All cases were followed up 24.5 months(12-39 months).The average length of the transfer fibula was 14.5 ± 3.2 cm.The average time for bone union at allograft-host junction was 5.5 ± 1.2 months.Of the 9 cases,the mean scores was 24 (their scores ranged from 20 to 27) at final follow-up.The functions of supplied regions were not found malfunctional,no recurrence of infection occurred.There were no stress fracture in inlay fibula.Conclusion Free vascularized fibular graft will benefit to control the infection in femur,have high bone union rate,and is an optimal choice.
