El-Alfy Barakat, Abulsaad Mazen, Abdelnaby Wail Lotfy
Department of Orthopedic Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Eur J Orthop Surg Traumatol. 2018 Aug;28(6):1191-1197. doi: 10.1007/s00590-018-2153-7. Epub 2018 Feb 14.
The aim of the present study is to assess the results of free nonvascularized fibular graft in the induced membrane technique to manage bone defects.
Fifteen patients with segmental skeletal defects were treated by the induced membrane technique using free nonvascularized fibular graft. The ages ranged from 20 to 48 years with an average of 32 years. The cause of the defects was post-traumatic bone loss in all cases. The defects were located in the distal femur in nine cases, proximal tibia in two cases and middle third of the tibia in four cases. The defects ranged from 5 to 14 cm with an average of 8 cm. All cases were treated by the induced membrane technique in two stages. Autogenous cancellous bone graft and free nonvascularized fibular graft were used to fill the defect in the second stage of surgery.
All cases healed without additional procedures after the second stage except in two cases. The time-to-bone union ranged from 4 to 13 months with an average of 7 months. After physiotherapy, all cases regained good range of ankle and knee movements except two cases. The complications included nonunion of the graft in two cases, deep wound infection in one case, and chronic pain along the iliac crest in one case. No cases were complicated by implant failure or refracture.
The use of free nonvascularised fibular graft in the induced membrane technique reduces the time of healing and improves the final outcome.
本研究旨在评估采用诱导膜技术使用游离无血管腓骨移植治疗骨缺损的效果。
15例节段性骨缺损患者采用诱导膜技术并使用游离无血管腓骨移植进行治疗。年龄范围为20至48岁，平均32岁。所有病例骨缺损的原因均为创伤后骨质丢失。9例骨缺损位于股骨远端，2例位于胫骨近端，4例位于胫骨中1/3。骨缺损长度为5至14厘米，平均8厘米。所有病例均分两阶段采用诱导膜技术治疗。在手术的第二阶段使用自体松质骨移植和游离无血管腓骨移植填充骨缺损。
除2例患者外，所有病例在第二阶段后均无需额外手术即愈合。骨愈合时间为4至13个月，平均7个月。经过物理治疗后，除2例患者外，所有病例踝关节和膝关节活动范围恢复良好。并发症包括2例移植骨不愈合、1例深部伤口感染和1例沿髂嵴慢性疼痛。无病例发生植入物失败或再骨折并发症。
在诱导膜技术中使用游离无血管腓骨移植可缩短愈合时间并改善最终治疗效果。
