Han C S, Wood M B, Bishop A T, Cooney W P
Department of Orthopedics, Mayo Clinic, Rochester, Minnesota 55905.
J Bone Joint Surg Am. 1992 Dec;74(10):1441-9.
We evaluated the results of reconstruction of a skeletal defect with use of a vascularized bone graft from the iliac crest or fibula in 160 patients who had been managed consecutively between 1979 and 1989. The indications for the procedure were a skeletal defect including non-union, resulting from resection of a tumor; traumatic bone loss; osteomyelitis; or a congenital anomaly. The average duration of follow-up was forty-two months (range, twelve to 112 months). For the entire series, the rate of union after the primary procedure was 61 per cent and the over-all rate at the latest follow-up examination (including the patients who had a secondary procedure) was 81 per cent. In a subgroup of seventy-six patients who had union after the primary procedure and did not have additional treatment, the average interval until union was six months and the average interval until full activity was sixteen months. The results were more favorable for the patients who had had reconstruction for resection of a tumor (of sixty-nine patients, fifty-six had union), for a congenital anomaly (of six patients, five had union), or for a non-union without infection (of twenty-five patients, twenty-three had union). The results were less satisfactory for patients who had had the reconstruction for bone loss due to osteomyelitis (of sixty patients, forty-six had union). Our data suggest that vascularized bone transfer for the reconstruction of large skeletal defects is a valuable procedure in appropriately selected patients.
我们评估了1979年至1989年间连续收治的160例患者使用取自髂嵴或腓骨的带血管骨移植修复骨骼缺损的结果。该手术的适应证包括因肿瘤切除导致的骨骼缺损，包括骨不连；创伤性骨丢失；骨髓炎；或先天性畸形。平均随访时间为42个月（范围为12至112个月）。对于整个系列，初次手术后的骨愈合率为61%，在最近一次随访检查时的总体愈合率（包括接受二次手术的患者）为81%。在初次手术后骨愈合且未接受额外治疗的76例患者亚组中，至骨愈合的平均间隔时间为6个月，至完全恢复活动的平均间隔时间为16个月。对于因肿瘤切除（69例患者中56例愈合）、先天性畸形（6例患者中5例愈合）或无感染的骨不连（25例患者中23例愈合）而接受重建的患者，结果更为理想。对于因骨髓炎导致骨丢失而接受重建的患者（60例患者中46例愈合），结果不太令人满意。我们的数据表明，对于适当选择的患者，带血管骨移植修复大的骨骼缺损是一种有价值的手术。
