Giebel Gregor M, Stöckle Ulrich, Ateschrang Atesch, Ahmad Sufian, Migliorini Filippo, Konrads Christian
Center for Musculoskeletal Surgery, Charité University Medical Center Berlin, Berlin, Germany.
Medical Faculty, University of Tübingen, Tübingen, Germany.
J Orthop. 2023 Mar 10;38:38-41. doi: 10.1016/j.jor.2023.02.017. eCollection 2023 Apr.
The management of medium-sized osseous defects and pseudoarthrosis of the tibia is challenging. This surgical technique aims to bridge medium-sized tibial defects using the fibula as a lead structure. The fibula and cancellous bone graft fuse with the tibia leading to synostosis.
Cortico-cancellous bone is harvested from the anterior iliac crest. The bone is shredded into small pieces of about 5 mm and mixed with stem cell-rich blood from the situs. Additionally, cancellous allografts can be used for expansion. The approach is extended along the interosseous membrane to reach the tibial defect. The pseudarthrosis is debrided and the tibial bone adjacent to the defect is decorticated. A 3.5 mm 1/3 tube plate is positioned to the fibula and fixed. Four quadricortical screws are positioned. Autograft is secured into the tibial bone defect and between the fibula and the tibia directly on the anterior surface of the interosseous membrane.
15 patients were followed up for a mean of 17 months. Osseous consolidation was achieved in 73.3% of all cases. On average, bone healing has occurred 17 weeks postoperatively. These patients did not have any pain walking with full weight bearing and without any walking aids at the last follow-up.
The fibula pro tibia procedure is a sufficient tool for treating non-unions of the mid and distal third of the tibia diaphysis in cases with a bony defect size of 1 cm-6 cm.
胫骨中型骨缺损和假关节的治疗具有挑战性。本手术技术旨在以腓骨为引导结构桥接胫骨中型缺损。腓骨和松质骨移植与胫骨融合导致骨连接。
从髂前嵴获取皮质松质骨。将骨切碎成约5毫米的小块，并与来自手术部位的富含干细胞的血液混合。此外，同种异体松质骨可用于扩大移植量。沿骨间膜延长切口以到达胫骨缺损处。清理假关节并对缺损相邻的胫骨骨进行去皮质处理。将一块3.5毫米的1/3管形钢板放置在腓骨上并固定。置入四枚双皮质螺钉。将自体骨固定于胫骨骨缺损处以及腓骨与胫骨之间，直接置于骨间膜的前表面。
15例患者平均随访17个月。所有病例中73.3%实现了骨愈合。平均而言，术后17周出现骨愈合。在最后一次随访时，这些患者在完全负重行走且无需任何助行器的情况下没有任何疼痛。
腓骨代胫骨手术是治疗胫骨骨干中、远三分之一处骨缺损大小为1厘米至6厘米的骨不连的一种有效方法。
