Falder S, Sinclair J S, Rogers C A, Townsend P L G
Department of Plastic and Reconstructive Surgery, North Bristol NHS Trust, Frenchay Hospital, Frenchay Park Road, Bristol BS16 1LE, UK.
Br J Plast Surg. 2003 Sep;56(6):571-84. doi: 10.1016/s0007-1226(03)00186-3.
Thirty-two free vascularised fibula grafts performed at our unit have been assessed retrospectively with respect to success, bony union and percentage graft hypertrophy. Between 1981 and 1998, there were 21 males and 11 females (aged 8-61 years) with follow-up of 5 months to 14.6 years. The mean bony defect bridged was 12.0 cm (standard deviation 4.8; range 5.0-21.0 cm). Bony union and hypertrophy were assessed radiographically. Time to bony union was compared using the log-rank, Wilcoxon or likelihood ratio tests. Kaplan-Meier survival curves were constructed. Hypertrophy was compared with Wilcoxon's rank sum test.Three flaps failed. Seventy-four percent of patients healed primarily at a median time of 4.75 months; five patients required further surgery to heal by 18 months (interquartile range 14-20 months). Complication rate and donor site morbidity were low. The stress fracture rate was 21%. Ninety percent of patients regained a functional limb by 12 months.Hypertrophy was measured in 22 patients and ranged from 0 to 316% (median 71%; interquartile range 10-145%). Median hypertrophy in the lower limb was 76.5% (interquartile range 26.5-165%) compared to 33.5% in the upper limb (0-88%); p=0.16. Median hypertrophy in trauma cases was 80% (interquartile range 10-167%) compared to 70% in tumour cases (33-105%); p=0.62.Our findings confirm that the fibula responds physiologically to biomechanical loading. Our results compare well with other series and alternative reconstructive modalities. We conclude that the free fibula flap can provide excellent results in the salvage of limbs with large bony defects.
我们对本单位实施的32例带血管游离腓骨移植进行了回顾性评估，内容包括手术成功率、骨愈合情况及移植骨肥大百分比。1981年至1998年间，共有21例男性和11例女性患者（年龄8 - 61岁），随访时间为5个月至14.6年。平均桥接的骨缺损为12.0厘米（标准差4.8；范围5.0 - 21.0厘米）。通过影像学评估骨愈合及肥大情况。采用对数秩检验、Wilcoxon检验或似然比检验比较骨愈合时间。构建Kaplan - Meier生存曲线。采用Wilcoxon秩和检验比较肥大情况。
3个皮瓣失败。74%的患者在中位时间4.75个月时实现一期愈合；5例患者需要进一步手术，至18个月时愈合（四分位间距14 - 20个月）。并发症发生率和供区发病率较低。应力性骨折发生率为21%。90%的患者在12个月时恢复了肢体功能。
对22例患者测量了移植骨肥大情况，范围为0至316%（中位值71%；四分位间距10 - 145%）。下肢移植骨肥大的中位值为76.5%（四分位间距26.5 - 165%），而上肢为33.5%（0 - 88%）；p = 0.16。创伤病例中移植骨肥大的中位值为80%（四分位间距10 - 167%），肿瘤病例为70%（33 - 105%）；p = 0.62。
我们的研究结果证实，腓骨对生物力学负荷有生理反应。我们的结果与其他系列研究及替代重建方式相比良好。我们得出结论，带血管游离腓骨瓣在挽救有大骨缺损的肢体方面可取得优异效果。
