Ring D, Jupiter J B, Toh S
Department of Orthopaedics, Massachusetts General Hospital, Boston, USA.
Plast Reconstr Surg. 1999 Aug;104(2):426-34. doi: 10.1097/00006534-199908000-00016.
Ten male patients with previously infected bony defects involving both sides of an articulation underwent arthrodesis using a vascularized fibular transfer. The average age of these patients was 38 years (range, 20 to 60 years). The size of the bony defect averaged 9 cm (range, 3 to 21 cm). The ankle was involved in five patients, the knee in two patients, the wrist in two patients, and the elbow in one patient. Nine cases represented septic pseudarthroses (eight after trauma and one after attempted ankle arthrodesis). One patient had a defect across the wrist after debridement of a chronic infection. The patients were followed for an average of 71 months (range, 26 to 144 months). Nine patients healed after the index vascularized fibular transfer, and one patient (ankle arthrodesis) required a second cancellous bone-grafting procedure for delayed union at the junction of the fibula with the talus. Four of seven patients with lower limb involvement had residual leg length discrepancies averaging 5 cm (range, 3 to 8 cm), and one had a persistent 20-degree internal rotation deformity. Two of the patients with upper limb involvement had stiff digits. Five of the nine previously employed patients returned to their former occupation (including heavy labor in four cases). Complications included two wound separations, one case of instability of the donor ankle after removal of a large fibular graft (related in part to a prior injury), and one fracture at the junction of the fibular graft with the local bone 10 months after the index procedure, which united after plate fixation and application of autogenous cancellous bone graft. Arthrodesis using a transfer of vascularized fibular bone represents a viable option for limb salvage in the face of an infected transarticular bony defect.
十名男性患者因先前感染导致关节两侧出现骨缺损，接受了带血管腓骨移植关节融合术。这些患者的平均年龄为38岁（范围为20至60岁）。骨缺损大小平均为9厘米（范围为3至21厘米）。五名患者累及踝关节，两名患者累及膝关节，两名患者累及腕关节，一名患者累及肘关节。九例为感染性假关节（八例为创伤后，一例为踝关节融合术失败后）。一名患者在慢性感染清创术后腕部出现缺损。患者平均随访71个月（范围为26至144个月）。九名患者在首次带血管腓骨移植后愈合，一名患者（踝关节融合术）因腓骨与距骨连接处延迟愈合需要进行第二次松质骨移植手术。七名下肢受累患者中有四名残留腿长差异，平均为5厘米（范围为3至8厘米），一名患者存在持续20度的内旋畸形。两名上肢受累患者手指僵硬。九名先前有工作的患者中有五名恢复了原工作（其中四例包括重体力劳动）。并发症包括两例伤口裂开，一例在切除大块腓骨移植后供体踝关节不稳定（部分与先前损伤有关），一例在首次手术后10个月腓骨移植与局部骨连接处骨折，经钢板固定并应用自体松质骨移植后愈合。对于感染性跨关节骨缺损，采用带血管腓骨移植进行关节融合术是肢体挽救的可行选择。
