Takazawa Akira, Matsuda Satoshi, Fujioka Fumio, Uchiyama Shigeharu, Kato Hiroyuki
Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
J Pediatr Orthop. 2011 Jun;31(4):e20-4. doi: 10.1097/BPO.0b013e31821a5c01.
Free vascularized fibular graft (FVFG) has been recognized as a curative surgical treatment for congenital pseudarthrosis of the tibia (CPT). However, bone union is not always obtained in some patients, and refracture often occurs in others even after union is achieved. To avoid such complications, we have designed a new split-tibia coaptation technique (STCT) for FVFG.
We performed FVFG using STCT in 2 patients with CPT. Both the proximal and distal stumps of the tibia were split longitudinally into 2 with minimum tibial resection, and then a fibular graft was placed into the formed gutters and stabilized by external fixation.
Successful bone union was achieved at postoperative weeks 13 and 12, respectively. The diameter of each fibular graft was enlarged to 107% and 83% of the contralateral tibia, and refracture did not occur during the follow-up periods of almost 7 and 4 years. Both the patients could walk without any limitations.
This novel coaptation technique for FVFG provides early bone union, enlargement of graft diameter, and prevention against refracture in patients with CPT.
游离血管化腓骨移植术（FVFG）已被公认为是治疗先天性胫骨假关节（CPT）的一种根治性手术方法。然而，一些患者并不能实现骨愈合，而另一些患者即使实现了愈合，也常常会发生再骨折。为避免此类并发症，我们设计了一种用于FVFG的新型胫骨劈开对接技术（STCT）。
我们对2例CPT患者采用STCT进行FVFG。胫骨的近端和远端残端均纵向劈为两半，同时尽量减少胫骨切除，然后将腓骨移植骨置入形成的沟内，并通过外固定进行固定。
分别在术后第13周和第12周实现了成功的骨愈合。每根腓骨移植骨的直径分别增大至对侧胫骨的107%和83%，且在近7年和4年的随访期内均未发生再骨折。两名患者均可无限制地行走。
这种用于FVFG的新型对接技术可使CPT患者实现早期骨愈合、移植骨直径增大并预防再骨折。
