CAJ | 학술논문

目的：探讨下肢长骨大段骨纤维结构不良导致大段骨缺损的修复方法，为临床治疗提供参考。方法6例骨纤维结构不良患者（胫骨损伤3例，股骨损伤3例），肿瘤切除后骨缺损长度（17．3±4．2）cm，均从双侧切取带腓血管腓骨于缺损另一端同腓血管吻合。双段腓骨前内侧骨膜从中央纵行切开剥离至骨嵴，将腓骨双段折叠后使其前内侧面相对，两端固定。将腓血管襻在移植体一侧形成U形。解剖出损伤区血管，将腓骨插入骨折两断端间，视情况加用钢丝或螺钉，使腓血管同损伤区血管吻合。术后对骨结合部愈合情况进行影像学评估，并采用美国骨肿瘤学会功能评分对术后功能进行评估，通过移植体出血情况检测血管吻合情况。结果所有患者随访5～8年，1年后均骨性愈合，5年后移植骨髓腔再通，双腓骨未发生肿瘤，X线显示愈合良好，均为正常骨骼，未发生骨不连、感染等并发症。终末随访下肢评分平均91．2分。结论骨膜内组合双腓骨修复骨纤维结构不良致下肢长骨大段缺损有效可行。
목적：탐토하지장골대단골섬유결구불량도치대단골결손적수복방법，위림상치료제공삼고。방법6례골섬유결구불량환자（경골손상3례，고골손상3례），종류절제후골결손장도（17．3±4．2）cm，균종쌍측절취대비혈관비골우결손령일단동비혈관문합。쌍단비골전내측골막종중앙종행절개박리지골척，장비골쌍단절첩후사기전내측면상대，량단고정。장비혈관반재이식체일측형성U형。해부출손상구혈관，장비골삽입골절량단단간，시정황가용강사혹라정，사비혈관동손상구혈관문합。술후대골결합부유합정황진행영상학평고，병채용미국골종류학회공능평분대술후공능진행평고，통과이식체출혈정황검측혈관문합정황。결과소유환자수방5～8년，1년후균골성유합，5년후이식골수강재통，쌍비골미발생종류，X선현시유합량호，균위정상골격，미발생골불련、감염등병발증。종말수방하지평분평균91．2분。결론골막내조합쌍비골수복골섬유결구불량치하지장골대단결손유효가행。
Objective To analyze the repair methods of bone defects caused by the harmful removal of lower extremity long bone segmental bone fibrous structure,and to provide reference for clinical treatment.Methods Six cases of patient with adverse fibrous structure,3 cases with the jnjury of backbone of the tibia and 3 cases of femoralshaft damage were conducted as the research objects.Bone defect length after tumor resection was (17.3 ±4.2)cm,inorder to coinside with the peroneal vessels in the other side,fibulas with peroneal vessels from both sides should be cutdown.Dual fibula medial periosteal was stripped from the central longitudinal incision to the bone crest,folding fibulatwo -stage to make the front sides face to face,and then fixed the ends.The peroneal vascular was looped on one sideof graft to form a U shape.The vessels out of damage region was dissected,and was inserted fibula between the ends offracture,as the case wire or screws may be used.The peroneal vessels had to coinside with those in damage region,andimaging assessment should be taken to evaluate the healing of bone joints after surgery,at the same time,assessingpostoperative function by functional scores of Bone Cancer Society of the United States was also neccessary,finallyvascular anastomosis through the bleeding condition of the grafts were detected.Results All patients were followedup for 5 -8 years,the bone healed 1 year later,and the transplanted bone marrow cavity got recanalization 5 years later,at the same time,there was no tumorigenesis in the double fibula,and x -ray showed the good healing.All bonesturned to be normal ones without nonunion,infection and other complications.Final follow -up score of lower limbswas 91.2%.Conclusion It is effective and feasible to use a combination of double fibula to repair lower extremitylong bone defects caused by large bone fibrous dysplasia in the periosteum.