Gordon L, Chiu E J
Department of Orthopaedic Surgery, University of California, San Francisco 94143-0728.
J Bone Joint Surg Am. 1988 Mar;70(3):377-86.
Fourteen patients who had an infected non-union or segmental defect of the tibia were treated with débridement and microvascular transplantation of muscle. Successful free muscle transplantation and control of the infection were achieved in all patients. The prognosis was, in general, related to the severity of the underlying osseous problems, which were categorized into types A (a tibial defect and non-union without significant segmental loss), B (a tibial defect that is more than three centimeters long and an intact fibula), and C (a tibial defect that is more than three centimeters long, involving both the tibia and the fibula). All of the six type-A patients healed without needing bone-grafting. Of the four type-B patients, all of whom had subsequent bone-grafting, reactivation of the infection occurred in two, and both ultimately had a below-the-knee amputation; the third patient had a non-union between the fibular graft and the tibia; and the fourth patient was fully weight-bearing. All of the four type-C patients also required subsequent bone-grafting; all finally healed and were able to walk with a brace. The results in the present series indicate that, in patients who have an infected tibial defect or non-union, including those that are so severe that an amputation might be considered, this method of treatment is a valid option for salvage of the limb.
14例患有胫骨感染性骨不连或节段性缺损的患者接受了清创术和肌肉微血管移植治疗。所有患者均成功进行了游离肌肉移植并控制了感染。总体而言，预后与潜在骨问题的严重程度相关，这些问题分为A 型（胫骨缺损和骨不连，无明显节段性缺失）、B型（胫骨缺损超过3厘米且腓骨完整）和C型（胫骨缺损超过3厘米，累及胫骨和腓骨）。6例A型患者均无需植骨即愈合。4例B型患者均进行了后续植骨，其中2例感染复发，最终均接受了膝下截肢；第3例患者腓骨移植与胫骨之间出现骨不连；第4例患者能够完全负重。4例C型患者也均需要进行后续植骨；最终均愈合，且能够借助支具行走。本系列研究结果表明，对于患有胫骨感染性缺损或骨不连的患者，包括那些病情严重到可能需要考虑截肢的患者，这种治疗方法是挽救肢体的有效选择。
