Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, PR China.
Injury. 2012 Jul;43(7):1090-5. doi: 10.1016/j.injury.2012.01.024. Epub 2012 Feb 18.
Free vascularised fibular grafting (FVFG) could be a good option for the restoration of massive bone defects in lower limbs when combined with use of a locking plate. The progress of fibular hypertrophy is closely related to regain of function, as well as to prevention of stress fractures. Multiple variables affecting fibular hypertrophy were investigated in the current study to elucidate correlative factors.
Eighteen patients with a massive bone defect in a lower limb reconstructed by FVFG combined with a locking plate were retrospectively enrolled in the current study. The degree of fibular hypertrophy was calculated based on the measurements from anteroposterior imaging at regular intervals of 3 months, 6 months, 1, 2 and 3 years postoperatively. Repeated measures analysis of variance was employed to evaluate and compare correlative factors including gender (male vs. female), age distribution (<30 years vs. >30 years), site (femur vs. tibia) and length of bone defect (6-10 cm vs. >10 cm), previous number of operations (once vs. more than twice) and concomitant infection (detected vs. non-detected).
All defects could be successfully repaired by FVFG and bone union was achieved uneventfully. The degree of fibular hypertrophy was 0.14%, 11.27%, 31.53%, 58.14% and 71.81% retrospectively at the five follow-up time points. Statistical analysis revealed that the above-mentioned factors did not affect the progress of fibular hypertrophy.
FVFG could be a good choice for the reconstruction of massive bone defects when combined with a locking plate. Factors including gender, age distribution, site and length of bone defects, number of previous operations and infection do not impact the progress of fibular hypertrophy, which implies that intrinsic factors might play an important role in restoration.
游离血管化腓骨移植（FVFG）联合锁定钢板可作为修复下肢大段骨缺损的一种较好选择。腓骨增粗的进展与功能恢复密切相关，也与预防应力性骨折有关。本研究调查了影响腓骨增粗的多个变量，以阐明相关因素。
回顾性纳入 18 例下肢大段骨缺损患者，采用 FVFG 联合锁定钢板重建。术后每 3 个月、6 个月、1 年、2 年和 3 年进行正位影像学测量，计算腓骨增粗程度。采用重复测量方差分析评估和比较相关因素，包括性别（男 vs. 女）、年龄分布（<30 岁 vs. >30 岁）、部位（股骨 vs. 胫骨）、骨缺损长度（6-10 cm vs. >10 cm）、既往手术次数（一次 vs. 两次以上）和伴感染（有 vs. 无）。
所有骨缺损均成功通过 FVFG 修复，骨愈合顺利。腓骨增粗程度分别在 5 个随访时间点（分别为 0.14%、11.27%、31.53%、58.14%和 71.81%）。统计分析显示，上述因素均不影响腓骨增粗进展。
FVFG 联合锁定钢板是修复大段骨缺损的较好选择。性别、年龄分布、部位和骨缺损长度、既往手术次数和感染等因素不影响腓骨增粗进展，这提示内在因素可能在恢复中起重要作用。
