Department of Orthopedics, The General Hospital of PLA, Lanzhou, 333 Southern Binhe Road, Lanzhou 730050, Gansu, People's Republic of China.
Arch Orthop Trauma Surg. 2011 Jan;131(1):93-9. doi: 10.1007/s00402-010-1121-4. Epub 2010 Jun 9.
Based on the considerable experience for management of combined bone and composite soft-tissue defects in the limbs by free vascularized fibula or osteocutaneous fibular flap grafting, the authors present the effective alternative for management of the severe comminuted tibial shaft fractures in one-stage reconstructive technique.
Twenty-six patients were male and 12 were female, and their mean age was 32 years (range 15-57 years). Ten tibial shaft fractures were closed and 28 were open. Based on the AO classification, there were 12 group C1 fractures and 24 group C3 fractures according to the fracture pattern and degree of comminution.
With the exception of eight cases that were delayed for 3-5 days for primary treatment in another hospital, 30 cases were treated on an emergency basis within an average of 12 h since the initial injury (range 6-22). Normal healing occurred in 31 fractures with a mean healing time of 21 weeks (range 18-24 weeks). Delayed union in 7 with a mean of 32 weeks (range 28-41 weeks), and there were no nonunion and infections. The vascularized fibula allows for fast bone fusion. In this context, the grafted fibula segment appeared to be a valuable reconstructive tool that offered good fracture stabilization and vascularised bone graft.
The attached fibular flap can also provide a large piece of mobile skin to cover the soft-tissue defect in grade III open-tibial fractures. It demonstrates that this early free vascularized fibula graft is a useful and effective option for treating the severe comminuted tibial shaft fractures.
作者在游离血管化腓骨或骨皮瓣移植治疗四肢骨与复合软组织缺损方面积累了丰富的经验，在此基础上提出了一期重建技术治疗严重粉碎性胫骨骨干骨折的有效方法。
男 26 例，女 12 例；年龄 15～57 岁，平均 32 岁。10 例胫骨骨折为闭合性，28 例为开放性。按 AO 分型：骨折类型和粉碎程度按 C1 型 12 例，C3 型 24 例。
除 8 例在另一家医院因初次治疗延迟 3～5 天外，其余 30 例均在受伤后平均 12 h（6～22 h）内进行了急诊治疗。31 例骨折愈合正常，愈合时间平均为 21 周（18～24 周）。7 例延迟愈合，平均 32 周（28～41 周），无骨不连和感染。带血管腓骨可快速骨融合。在这种情况下，移植的腓骨段似乎是一种有价值的重建工具，可提供良好的骨折稳定性和带血管骨移植。
游离腓骨瓣还可提供大块活动皮瓣覆盖Ⅲ度开放性胫骨骨折的软组织缺损。表明早期游离血管化腓骨移植是治疗严重粉碎性胫骨骨干骨折的一种有用且有效的方法。
