Vascularized fibular graft for repair of large segmental bone defects in the extremities

doi:10.3969/j.issn.2095-4344.2015.11.001

Abstract

Abstract:

BACKGROUND: Vascularuzed fibular graft is one of the effective methods for repair of large segmental bone defects in the extremities

OBJECTIVE: To explore the clinical effects of vascularized fibular graft for repairing large segmental bone defects in the extremities.

METHODS: Twenty-eight non-malignant patients who received vascularized fibular graft for repairing large segmental bone defects in the extremities and were followed up for more than 20 months were enrolled. After lesion removal, vascularized fibula bone graft was used to repair the bone defects. If cases combined with soft tissue defects, fibula flap or anterolateral thigh flap was adopted.

RESULTS AND CONCLUSION: All patients were followed up for 20 months to 6 years. The grafted bones were healed with the surrounding bone at 3-8 months after fibula bone grafting. The grafted bone was enlarged near to the diameter of recipient bone at 10-22 months after grafting. Based on the Enneking system, the average score of large segmental tibia bone defects was 24.2 points with 81% limb function recovered and 94.1% patient satisfaction; the average score of large segmental femur bone defects was 26.3 points with 87.7% limb function recovered and 100% patient satisfaction; the average score of large segmental bone defects of the distal radius and ulna was 21.75 points with 72.5% limb function recovered and 100% patient satisfaction. These findings reveal that vascularized fibular graft for repairing large segmental bone defects in extremities can effectively promote bone healing and reduce disability, infection, amputation rate; moreover, patients are satisfied with the postoperative recovery of limb function.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

全文链接：

Key words: Fibula, Transplantation, Fractures, Bone, Extremities

CLC Number:

R318

Li Yuan-hui, Yang Yun-fa, Hu Han-sheng, Zhang Guang-ming, Yu Sheng-hua, Zeng Mian-dong, Fan Zhen-bo. Vascularized fibular graft for repair of large segmental bone defects in the extremities[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(11): 1641-1646.

Figures/Tables 1

2.1 参与者数量分析纳入患者28例，所有患者出院后均得到20个月至6年的随访，平均随访28个月，全部进入结果分析。 2.2 患者治疗后随访时肢体功能评分、影像学、供区观察结果 2.2.1 胫骨大段骨缺损肢体功能评价：本组17例患者腓骨移植后肢体功能评分平均24.2分，肢体功能恢复81%，患者对手术满意程度达94%，所有患者均无出现移植骨部位疼痛不适，1例先天性胫骨假关节患者存在一定程度的肢体功能受限，5例患者出现轻度跛行，但对手术效果满意，其余患者均对手术效果非常满意。影像学观察：15例患者的移植腓骨两端与胫骨均在术后3-7个月获得骨性愈合，2例病例出现慢性骨髓炎，经对症治疗后骨愈合，1例患者在移植腓骨与胫骨达到骨愈合后过早负重出现移植腓骨中段骨折，予石膏固定术后3个月骨折愈合。所有患者均在腓骨移植后10-18个月，移植腓骨直径增粗致接近受区胫骨直径。供区随访观察：1例2岁小孩出现供区踝关节外翻畸形，予手术矫形。供区均无疼痛及腓总神经支配区感觉异常。2例患者术后供区踇长伸肌肌力2级。其余病例供区均无明显损害，踝关节活动不受限。 2.2.2 股骨骨缺损肢体功能评价：本组7例股骨大段骨缺损腓骨移植术后功能评分平均26.3分，肢体功能恢复88%，患者对手术满意度100%。2例患者术后膝关节活动轻度受限，出现轻度跛行，但患者对手术效果满意。影像学观察：所有患者移植腓骨两端与股骨均在术后4-8个月获得骨性愈合，1患者过早负重出现移植腓骨骨折，予床边持续骨牵引后3个月骨折愈合。所有患者均在腓骨移植术后17-22个月，移植腓骨直径增粗致接近受区股骨直径。供区随访观察：本组病例未发生供区踝关节外翻畸形，无疼痛及腓总神经支配区感觉异常。1例病例术后踇长伸肌、腓骨长短肌肌力3至4级。所有患者的踝关节活动均不受限。 2.2.3 桡尺骨远端骨缺损肢体功能评价：4例桡尺骨远端肿瘤切除后腓骨移植术后肢体功能评分平均21.75分，肢体功能恢复72.5%，3例患者术后腕关节功能大部分恢复，1例术后腕关节屈伸、旋转功能小于10°；但4例患者均对手术满意。影像学观察：4病例术后X射线显示形态替代满意，3个月内与受区骨端骨性愈合；2例年龄为别为5岁及8岁病例移植腓骨侧生长较健侧骨缓慢，随访发现时间越长移植腓骨侧较健侧短缩越明显。供区随访观察：本组病例未发生供区踝关节外翻畸形，无疼痛及腓总神经支配区感觉异常，踇长伸肌、腓骨长短肌肌力4至5级。踝关节活动均不受限。 2.3 不良反应 2例腓骨皮瓣、皮岛术后24 h内出现皮瓣发暗、水肿、起水泡，考虑为静脉危象，急诊手术探查发现静脉血栓形成，予手术取出血栓后腓骨皮瓣/岛静脉回流改善，颜色等恢复正常。 2例下肢骨缺损腓骨移植术后过早负重出现移植腓骨骨折，经保守治疗后骨折愈合。 2.4 典型病例男，58岁，车祸致右小腿开放性骨折，在外院行清创骨折复位髓内钉内固，术后胫前皮肤坏死，胫骨外露。入本院后予清创，髓内钉拆除，感染病灶骨清除，带血管复合腓骨皮瓣移植，移植后皮瓣及腓骨成活。随访20个月，创面覆盖，腓骨增粗，行走正常。见图1。"

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