CAJ | 학술논문

目的：探讨静脉移植桥接血管蒂的游离腓骨瓣移植治疗长骨感染性骨缺损及软组织缺损的手术方法及临床疗效。方法回顾性分析自2008年6月至2014年1月收治的17例长骨感染性骨缺损患者病例资料，男11例，女6例；年龄1.5~55岁，平均31.3岁；股骨8例，胫骨5例，肱骨3例，桡骨1例；骨缺损长度为4~19 cm，平均9.4 cm；其中8例合并软组织缺损（5.0 cm×3.0 cm~17.0 cm×5.5 cm）。感染性骨缺损端彻底清创后，负压封闭灌洗引流2~3周，待肉芽生长新鲜，设计并切取腓骨瓣或腓骨皮瓣移植进行重建，移植自体静脉并端端吻合桥接受区血管与腓骨瓣的血管蒂。静脉移植桥接腓骨瓣的动、静脉血管蒂长度5~18 cm，平均9.6 cm；移植腓骨皮瓣面积6.5 cm×4.0 cm~18.0 cm×6.0 cm。结果17例腓骨瓣手术及术后恢复顺利，均无血管危象。伤口一期愈合11例，延期1~2周愈合6例。术后6~8周X线片示移植腓骨端骨痂形成。15例获得随访，随访9个月~6年，平均30个月，2例失访。13例骨缺损一期愈合，2例腓骨一端与受区未愈合，再次手术后愈合。1例移植腓骨术后7个月发生应力骨折，经外固定架治疗4个月后愈合。感染性骨缺损愈合时间4.2~9.8个月，平均5.9个月，末次随访时采用Enneking系统评分，优11例，良3例，可1例，优良率93.3%。手术后肢体功能恢复满意。结论静脉移植桥接游离腓骨（皮）瓣血管蒂，不仅能有效地修复长骨感染性骨缺损和局部软组织缺损，而且可以改善骨缺损局部血运，控制感染，明显缩短疗程，是治疗肢体长骨感染性骨缺损及合并软组织缺损的有效手段。
목적：탐토정맥이식교접혈관체적유리비골판이식치료장골감염성골결손급연조직결손적수술방법급림상료효。방법회고성분석자2008년6월지2014년1월수치적17례장골감염성골결손환자병례자료，남11례，녀6례；년령1.5~55세，평균31.3세；고골8례，경골5례，굉골3례，뇨골1례；골결손장도위4~19 cm，평균9.4 cm；기중8례합병연조직결손（5.0 cm×3.0 cm~17.0 cm×5.5 cm）。감염성골결손단철저청창후，부압봉폐관세인류2~3주，대육아생장신선，설계병절취비골판혹비골피판이식진행중건，이식자체정맥병단단문합교접수구혈관여비골판적혈관체。정맥이식교접비골판적동、정맥혈관체장도5~18 cm，평균9.6 cm；이식비골피판면적6.5 cm×4.0 cm~18.0 cm×6.0 cm。결과17례비골판수술급술후회복순리，균무혈관위상。상구일기유합11례，연기1~2주유합6례。술후6~8주X선편시이식비골단골가형성。15례획득수방，수방9개월~6년，평균30개월，2례실방。13례골결손일기유합，2례비골일단여수구미유합，재차수술후유합。1례이식비골술후7개월발생응력골절，경외고정가치료4개월후유합。감염성골결손유합시간4.2~9.8개월，평균5.9개월，말차수방시채용Enneking계통평분，우11례，량3례，가1례，우량솔93.3%。수술후지체공능회복만의。결론정맥이식교접유리비골（피）판혈관체，불부능유효지수복장골감염성골결손화국부연조직결손，이차가이개선골결손국부혈운，공제감염，명현축단료정，시치료지체장골감염성골결손급합병연조직결손적유효수단。
Objective To explore the surgical method and curative effect of free vascularized fibular graft bridged vascu?lar pedicle by vein transplantation for infective long bone defect with or without soft tissue defect reconstruction. Methods From June 2008 to January 2014, 17 patients with infective long bone defect were treated, 11 male and 6 female, 1.5 to 55 years old and averaged 31.3 years. 8 cases in femur, 5 cases in tibia, 3 cases in humerus and 1 case in radius. Bone defect were 4 to 19 cm in length with an average of 9.4 cm. 8 cases with soft tissue defect, from 5.0 cm×3.0 cm to 17.0 cm×5.5 cm. Required adequate surgi?cal debridement, and vacuum sealing drainage (VSD) was used. Free vascularized fibular (skin) flap was designed and harvested . Artery and veins close to the health site were dissected, and bridged vascular pedicle of free vascularized fibular flap by autolo?gous vein transplantation with end to end anastomosis. The length free vascularized fibular graft was from 5 to 18 cm, with an aver?age of 9.6 cm. The free fibula flap ranged from 6.5 cm×4.0 cm to 18.0 cm×6.0 cm. Results All the 17 cases of fibular flap sur?vived, no vascular crisis happened. Post?operative wound primary healed in 11 cases, delayed 1 to 2 weeks to heal in 6 cases. Cal?lus was seen in the 6 to 8 weeks later. 15 cases were followed from 9 months to 6 years (averaged 30 months) while 2 cases were lost to follow?up. Bone defect primary healed in 13 cases, and the fibula graft unhealed in 2 cases, but healed again after a second operation. Fibula stress fracture occurred in one case at 7 months after grafting procedures and bone union was achieved 4 months after reapplying an external fixator. Infected bone defect healing time ranged from 4.2 to 9.8 months, averaged 5.9 months. Accord?ing to the Enneking score, 11 cases were excellent, good in 3 cases, one in fair. Excellent and Good rate was 93.3%. Conclusion Free vascularized fibular (skin) graft with vein bridged vascular pedicle can not only effectively repair infected bone and soft tissue defect, but also improve local blood supply and control infection, shorten the course of treatment, which is an effective treatment of infective long bone defects with or without soft tissue defects.