Minami A, Kasashima T, Iwasaki N, Kato H, Kaneda K
Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Sapporo, Japan.
J Bone Joint Surg Br. 2000 Sep;82(7):1022-5. doi: 10.1302/0301-620x.82b7.10332.
The results and complications of 104 vascularised fibular grafts in 102 patients are presented. Bony union was ultimately achieved in 97 patients, with primary union in 84 (84%). The mean time to union was 15.5 weeks (8 to 40). In 13 patients, primary union was achieved at one end of the fibula and secondary union at the other end. In these patients, the mean time to union was 31.1 weeks (24 to 40). Five patients failed to achieve union, with a resultant pseudarthrosis (3 patients) or amputation (2 patients). There were various complications. Immediate thrombosis occurred in 14 cases. In two of 23 patients with osteomyelitis, infection recurred at two and six months after surgery, respectively. Both patients had active osteomyelitis less than one month before the operation. Bony infection occurred in a patient with a synovial sarcoma of the forearm one year after surgery. In 15 patients, 19 fractures of the fibular graft occurred after bony union, all except one within one year after union. In patients in whom an external fixator had been used, fracture occurred soon after its removal. Union was difficult to achieve in cases of congenital pseudarthrosis of the tibia. Appropriate alignment of the fibular graft is an important factor in preventing stress fracture. The vascularised fibula should be protected during the first year after union. Postoperative complications at the donor site included transient palsy of the superficial peroneal nerve in three patients, contracture of flexor hallucis longus in two and valgus deformity of the ankle in three. Vascularised fibular grafts are useful in the reconstruction of massive bony defects. We believe that meticulous preoperative planning, including choosing which vessels to select in the recipient and the type of fixation devices to use, and care in the introduction of the vascularised fibula, can improve the results and prevent complications.
本文报告了102例患者接受104例带血管腓骨移植的结果及并发症。97例患者最终实现了骨愈合，其中84例（84%）为一期愈合。平均愈合时间为15.5周（8至40周）。13例患者中，腓骨一端实现了一期愈合，另一端为二期愈合。这些患者的平均愈合时间为31.1周（24至40周）。5例患者未能实现愈合，导致假关节形成（3例）或截肢（2例）。出现了各种并发症。14例发生了即刻血栓形成。23例骨髓炎患者中有2例分别在术后2个月和6个月感染复发。这2例患者在手术前不到1个月均有活动性骨髓炎。1例前臂滑膜肉瘤患者在术后1年发生了骨感染。15例患者在骨愈合后发生了19例腓骨移植骨折，除1例外均在愈合后1年内发生。使用外固定架的患者在拆除外固定架后不久发生了骨折。胫骨先天性假关节病例难以实现愈合。腓骨移植的适当对线是预防应力性骨折的重要因素。带血管腓骨在愈合后的第一年应予以保护。供区的术后并发症包括3例患者出现腓浅神经短暂麻痹，2例出现拇长屈肌挛缩，3例出现踝关节外翻畸形。带血管腓骨移植在重建大块骨缺损方面很有用。我们认为，精心的术前规划，包括选择受区的血管及使用的固定装置类型，以及在引入带血管腓骨时的小心操作，可改善结果并预防并发症。
