Muramatsu K, Ihara K, Shigetomi M, Kawai S
Department of Orthopedic Surgery, Yamaguchi University School of Medicine, 1-1-1 Minami-Kogushi, Ube, 755-8505 Yamaguchi, Japan.
Br J Plast Surg. 2004 Sep;57(6):550-5. doi: 10.1016/j.bjps.2003.08.021.
We reviewed 17 patients for a mean of 25 months period after free vascularised fibular transfer to reconstruct massive bone defect or recalcitrant nonunion of the femur. There were 11 cases of posttraumatic nonunion and six patients had a large bony defect following resection of bone tumour. Ten patients underwent double or folded and seven patients underwent single vascularised fibula graft transfer. Mean bony defect of the femur was 6.5 cm and mean length of grafted fibula was 15 cm. Revision surgery due to postoperative vascular complications was required in five cases. Twenty-three out of 24 (96%) vascularised fibulas were transferred successfully. The resultant outcome was successful in 15 out of 16 (94%) patients with confirmed bone union. Stress fracture occurred in three inlay fibula grafts. Hypertrophic change of the fibula graft was significantly noted in inlay grafts as compared to onlay grafts. All patients could walk without brace at a mean of 11 months postoperatively. Donor-site morbidity was minimum. Vascularised fibula grafting is a reliable and safe reconstructive procedure for massive femur defects. Folded or double fibula grafts cannot prevent stress fractures and the key point is to rigidly stabilise the femur in an anatomically aligned position.
我们对17例患者进行了回顾性研究，这些患者在接受游离带血管腓骨移植以重建股骨大块骨缺损或顽固性骨不连后，平均随访了25个月。其中创伤后骨不连11例，6例患者在骨肿瘤切除后出现大块骨缺损。10例患者接受了双折或折叠带血管腓骨移植，7例患者接受了单根带血管腓骨移植。股骨平均骨缺损为6.5 cm，移植腓骨平均长度为15 cm。5例患者因术后血管并发症需要进行翻修手术。24根带血管腓骨中有23根（96%）成功移植。16例（94%）确诊骨愈合的患者中，15例结果成功。3例嵌插腓骨移植发生应力性骨折。与贴附移植相比，嵌插移植中腓骨移植的肥大改变明显。所有患者术后平均11个月时无需支具即可行走。供区并发症最少。带血管腓骨移植是一种可靠且安全的重建股骨大段缺损的手术方法。折叠或双腓骨移植不能预防应力性骨折，关键在于将股骨牢固稳定在解剖复位的位置。
