Amr S M, el-Mofty A O, Amin S N
Abteilung für Orthopädie und Unfallchirurgie der Universität Kairo, Agypten.
Handchir Mikrochir Plast Chir. 2001 May;33(3):153-61. doi: 10.1055/s-2001-15123.
We are presenting our experience with vascularized epiphyseal transplantation of the upper end of the fibula, based distally on the anterior tibial artery in two patients, one suffering from septic epiphysitis of the hip with complete loss of the head and neck of the femur, the other suffering from radial club hand following septic loss of the radius, excluding its proximal and distal articular segments. In the first patient, the fibular epiphysis bridged the bone defect and provided growth at the neck of the femur. This restored hip stability, reduced limb-length discrepancy, initiated some degree of acetabular development, and maintained a functional range of hip motion. In the second patient, transplantation of the upper end of the fibula was used to bridge a gap resulting from complete resorption of the right radius and provide for growth of the radius. At follow-up, complete union of the graft was noted. The club-hand appearance improved markedly. Pronation and supination were regained. However, donor-site morbidity was a problem. It included sloughing of part of the peroneal muscles and the skin edge of the incision. This was due to loss of the anterior tibial artery as well as injury to the peroneal vessel collaterals supplying the skin and peroneal muscles. The latter occurred due to opening of the posterior compartment of the leg in an attempt to locate the anterior tibial artery at its origin from the popliteal artery. It is therefore concluded, that transplantation of the upper end of the fibula is a valuable reconstructive alternative for septic epiphysitis with complete loss of the head and neck of the femur as well as for septic loss of the radius. However, whenever an extended part of the upper end of the fibula needs being harvested, this should be performed through an anterior approach, in order to avoid sloughing of the skin and muscles of the anterior and lateral compartments of the leg.
我们报告两例基于胫前动脉远端进行带血管蒂腓骨上端骨骺移植的经验。一例患者患有髋部感染性骨骺炎，股骨头和股骨颈完全缺失；另一例患者患有桡骨感染后缺失，不包括其近端和远端关节段，导致桡侧多指畸形。在第一例患者中，腓骨骨骺桥接了骨缺损并促进了股骨颈的生长。这恢复了髋关节稳定性，减少了肢体长度差异，启动了一定程度的髋臼发育，并维持了髋关节的功能活动范围。在第二例患者中，腓骨上端移植用于桥接右桡骨完全吸收导致的间隙，并促进桡骨生长。随访时，发现移植骨完全愈合。多指畸形外观明显改善。恢复了旋前和旋后功能。然而，供区并发症是个问题。包括部分腓骨肌和切口皮肤边缘的坏死。这是由于胫前动脉丧失以及供应皮肤和腓骨肌的腓血管侧支损伤所致。后者是在试图从腘动脉找到胫前动脉起始处时打开小腿后室导致的。因此得出结论，腓骨上端移植对于股骨头和股骨颈完全缺失的感染性骨骺炎以及桡骨感染性缺失是一种有价值的重建选择。然而，每当需要获取腓骨上端的延伸部分时，应通过前路进行，以避免小腿前外侧室皮肤和肌肉的坏死。
