Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Arch Orthop Trauma Surg. 2010 Jun;130(6):781-6. doi: 10.1007/s00402-009-1042-2. Epub 2010 Jan 9.
To validate the hypothesis that the reconstruction of the missing segment of the fibula using a redundant split fibular graft after a vascularized fibular flap transfer may have a better effect on ankle function.
Of the 24 head and neck cancer patients who received a free fibula flap for mandible reconstruction, 14 patients underwent the conventional method of donor site closure, in which the redundant fibular bone was discarded (Group I). Ten patients underwent longitudinal osteotomy of the redundant non-vascularized fibular portion to bridge the donor site defect (Group II). Postoperative subjective satisfaction level was evaluated with a self-constructed questionnaire in 10 parameters (ambulation with assistance, ankle instability, ankle stiffness, muscle weakness, leg edema, foot numbness, ankle pain, other sites of pain besides the ankle, and restriction to run) and the 4 voluntary motions (dorsiflexion, plantar flexion, eversion, and inversion) of both ankles were measured using a CYBEX II dynamometer.
The muscle peak torque of the donor leg was significantly lower at ankle plantar flexion (P = 0.002), eversion (P = 0.002), and inversion (P = 0.0002) in Group I as well as at dorsiflexion (P = 0.031), plantar flexion (P = 0.016), and inversion (P = 0.002) in Group II against the contralateral non-operated leg. The muscle power was significantly greater when performing ankle eversion (P = 0.049) in those who underwent split fibular bone reconstruction. There was no difference in the subjective satisfaction score between these two groups.
The reconstruction of the donor site with a split fibular bone graft led only a slight improvement in ankle eversion.
为了验证以下假设，即使用血管化腓骨皮瓣转移后冗余的腓骨分段移植来重建腓骨缺失段，可能对踝关节功能有更好的效果。
在 24 例接受游离腓骨瓣进行下颌骨重建的头颈部癌症患者中，14 例患者采用常规的供区关闭方法，即丢弃多余的腓骨骨（I 组）。10 例患者采用冗余非血管化腓骨部分的纵向截骨术来桥接供区缺损（II 组）。通过 10 个参数（助行器辅助行走、踝关节不稳定、踝关节僵硬、肌肉无力、腿部水肿、足部麻木、踝关节疼痛、踝关节以外的其他疼痛部位以及跑步受限）的自我构建问卷评估术后主观满意度水平，并使用 CYBEX II 测力计测量双侧踝关节的 4 个主动运动（背屈、跖屈、外翻和内翻）。
I 组患者在踝关节跖屈（P = 0.002）、外翻（P = 0.002）和内翻（P = 0.0002）时，以及 II 组患者在踝关节背屈（P = 0.031）、跖屈（P = 0.016）和内翻（P = 0.002）时，供腿的肌肉峰值扭矩显著降低。在进行踝关节外翻时，接受腓骨分段重建的患者肌肉力量显著增加（P = 0.049）。两组患者的主观满意度评分无差异。
用腓骨分段移植物重建供区仅能略微改善踝关节外翻。
