Orthopaedic Department, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
J Trauma Acute Care Surg. 2012 May;72(5):1404-10. doi: 10.1097/TA.0b013e31824473ce.
Subtrochanteric fractures of the femur complicated with segmental bone defects are uncommon injuries and challenging to manage. We evaluated the effect of reconstructing extensive bone defect in the subtrochanteric area (mean, 6.9 cm) with folded free vascularized fibular graft (FVFG).
Between 2001 and 2007, 14 cases of subtrochanteric fractures complicated with huge bone defects treated by folded FVFG transfer in our hospital were retrospectively reviewed. The defect was reconstructed by folded FVFG transfer and locking plate stabilization in 10 patients with no sign of infection at admission (group 1). In the other four patients presented with infections (group 2), the defect was reconstructed by folded FVFG transfer and external fixator fixation. The average follow-up period was 67.4 months.
Bone union was achieved in all of the cases at an average of 5.4 months (range, 4-6 months). Primarily, bone union was achieved in all of the cases in group 1, but one stress fracture occurred in group 2. The full weight bearing time was 5.4 months (range, 5-6 months) in group 1 and 8.5 months (range, 8-9 months) in group 2. Seven patients in group 1 had the locking plate removed in an average of 27 months (range, 18-38 months). In group 2, the external fixator removal time was 13 months (range, 10-18 months). There was no varus deformity at the final follow-up in group 1. The neck-shaft angle measured during the postoperative period and at final follow-up was 129.6 degrees and 129.4 degrees, respectively. In group 2, the neck-shaft angle at the final follow-up was significantly less than the angle measured at the postoperative period (115.5 vs. 129.5 degree, p = 0.021). The range of motion of the hip and knee joint (extend and flex) was 100 degrees or more in all patients at the final follow-up.
The results of this study showed that huge subtrochanteric bone defects reconstructed by folded FVFG and locking plate were highly successful in achieving bone union, reducing risks of postoperative stress fracture and preventing malunion. When huge bone defects in the subtrochanteric area complicated with acute or chronic infections, the technique of external fixator offers an alternative to reconstruct the stability of the proximal femur after folded FVFG. However, because of the inadequate stabilization, the risks of varus malunion and postoperative stress fracture could be increased after external fixator fixation.
V, therapeutic study.
股骨转子下骨折合并节段性骨缺损较为少见，治疗具有挑战性。我们评估了折叠游离腓骨移植（FVFG）重建转子下广泛骨缺损的效果。
2001 年至 2007 年，我院收治 14 例转子下骨折合并巨大骨缺损患者，回顾性分析采用折叠 FVFG 转移治疗的病例。10 例无感染迹象的患者（组 1）采用折叠 FVFG 转移和锁定钢板固定重建缺损；4 例有感染的患者（组 2）采用折叠 FVFG 转移和外固定架固定重建缺损。平均随访 67.4 个月。
所有患者均在平均 5.4 个月（范围 4-6 个月）实现骨愈合。组 1 所有患者均实现了骨愈合，但组 2 中有 1 例发生应力性骨折。组 1 患者完全负重时间为 5.4 个月（范围 5-6 个月），组 2 为 8.5 个月（范围 8-9 个月）。组 1 中有 7 例患者在平均 27 个月（范围 18-38 个月）时取出锁定钢板。组 2 患者外固定架去除时间为 13 个月（范围 10-18 个月）。组 1 患者最终随访时无内翻畸形。术后和最终随访时颈干角分别为 129.6 度和 129.4 度。组 2 患者最终随访时颈干角明显小于术后测量值（115.5 度 vs. 129.5 度，p = 0.021）。所有患者最终随访时髋关节和膝关节活动度（伸展和屈曲）均为 100 度或以上。
本研究结果表明，折叠 FVFG 和锁定钢板重建巨大转子下骨缺损可高度成功地实现骨愈合，降低术后应力性骨折的风险，并防止愈合不良。当转子下区巨大骨缺损合并急性或慢性感染时，外固定架技术可为折叠 FVFG 后重建股骨近端稳定性提供一种替代方法。然而，由于固定不充分，外固定架固定后内翻畸形和术后应力性骨折的风险可能增加。
V，治疗研究。
