Chief Plastic and Reconstructive Microsurgery Service, FREMAP Hospital. Majadahonda, Madrid, Spain.
J Plast Reconstr Aesthet Surg. 2011 Apr;64(4):515-27. doi: 10.1016/j.bjps.2010.06.035. Epub 2010 Aug 3.
The corticoperiosteal flap from the medial femoral condyle (CP) has proved to be highly reliable in the management of persistent, recurrent nonunion. However, much of the related literature has focussed on the flap aspects of the procedure and not so much on bone work-up. We present a series of 25 patients with nonunions and small bone gaps irresponsive to conventional therapy that were successfully treated with a CP with/without the addition of non-vascularised bone graft from the iliac crest. Different technical options of bone reconstruction are possible and discussed: CP plus non-structural bone chips, CP plus structural bi/tricortical struts or CP plus vascularised cancellous bone from the femoral condyle. A stable internal fixation was performed in all cases. Clinical and radiological evidence of healing was obtained in all the patients. Donor-site complications were few and transient (suture intolerance, seroma and numbness in the saphenous territory). No fracture of the femur, knee instability or stiffness has been observed. The corticoperiosteal flap from the femoral condyle is an excellent source of vascularisation and osteogenic stimulus to the nonunion site and highly effective in the management of persistent nonunions and small bone gaps. When needed, a structural corticocancellous strut from the iliac crest (along with a stable internal fixation) provides the greatest stability and the possibility of a prompt rehabilitation and functional recovery. The corticoperiosteal flap has succeeded in revascularising these highly demanding grafts and in allowing a 100% union rate.
取自股骨内髁的骨膜-皮质骨瓣（CP）在治疗持续性、复发性骨不连方面已被证明具有高度可靠性。然而，许多相关文献都集中在该手术的皮瓣方面，而不是骨处理方面。我们报告了一组 25 例非愈合和小骨间隙患者，这些患者对常规治疗无反应，成功地接受了 CP 治疗，同时/不添加来自髂嵴的非血管化骨移植物。可以采用不同的骨重建技术选项，并进行了讨论：CP 加非结构性骨屑、CP 加结构性双/三皮质支柱或 CP 加来自股骨髁的血管化松质骨。所有病例均采用稳定的内固定。所有患者均获得了临床和影像学愈合证据。供区并发症很少且短暂（缝线不耐受、滑囊区域的血清肿和麻木）。未观察到股骨骨折、膝关节不稳定或僵硬。股骨髁的骨膜-皮质骨瓣是向骨不连部位提供血管化和成骨刺激的极好来源，在治疗持续性骨不连和小骨间隙方面非常有效。在需要时，来自髂嵴的结构性皮质松质骨支柱（以及稳定的内固定）可提供最大的稳定性和快速康复及功能恢复的可能性。骨膜-皮质骨瓣成功地使这些高要求的移植物重新血管化，并实现了 100%的愈合率。
