Chacha P B
Int Orthop. 1984;8(2):117-38. doi: 10.1007/BF00265834.
When a massive free bone graft has to be incorporated into a large bone defect in the presence of a poor vascular recipient bed, the risks of absorption and failure of the graft to revascularise are high. Experimental studies have confirmed that a bone graft transferred to its recipient site with an intact pedicle of blood supply remains viable, and unites directly with the recipient bone without having to be revascularised and replaced by creeping substitution. It also provides a live bone bridge for reconstruction of a massive bone defect, and is a ready source of vascular osteogenic tissue which sprouts new outgrowths to revascularise avascular recipient bone. A vascularised bone graft can be raised on a pedicle of muscle attachment or a main axial vessel, but the mobility of the vascularised pediculated graft is limited by the length of its pedicle. The vascularised muscle-pedicle graft of the ipsilateral fibular shaft described by Chacha et al has been proved viable both in monkeys and in humans. The shaft is raised on a pedicle of the peroneal vessels and the peroneal and the anterior tibial muscles, and provides an excellent viable bone strut to bridge a large defect in the tibial shaft. Judet's quadratus femoris muscle-pedicle graft from the greater trochanter has proved superior to Phemister's tibial cortical or fibular strut graft for the treatment of non-union of the femoral neck and the silent-phase of avascular necrosis of the femoral head. The tensor fascia lata muscle-pedicle graft of the anterior iliac crest, described by Davies and Taylor, provides a good viable bone strut for anterior hip fusion and for filling defects in the acetabulum and the upper femur. The whole of the greater trochanter attached to a thick pedicle of the gluteal muscles can be used as a live extra-articular graft for hip fusion. A pedicular rib graft raised on its intercostal vessels, as described by Rose et al. and Bradford, is a very useful live bone strut for correction of kyphosis and grafting of infective lesions of the vertebral bodies. The cortical graft of the radius within the radial forearm skin flap for reconstruction of the thumb, the pronator quadratus muscle-pedicle graft of the lower radius for non-union of the scaphoid and avascular necrosis of the lunate, and the erector spinae muscle-pedicle graft of the posterior ilium for intertransverse fusion are new concepts which need to be evaluated for wider clinical application.
当需要将一块巨大的游离骨移植到血运较差的受区大骨缺损处时，骨吸收以及移植骨未能实现血管化的风险很高。实验研究证实，带完整血供蒂转移至受区的骨移植体能够存活，并直接与受区骨愈合，无需经历血管化过程以及通过爬行替代被新骨取代。它还为巨大骨缺损的修复提供了一条有活力的骨桥，并且是血管化骨生成组织的现成来源，能长出新的分支使无血运的受区骨实现血管化。带血管蒂骨移植可以基于肌肉附着蒂或主要轴向血管掀起，但带血管蒂移植骨的活动度受其蒂长度的限制。查查等人描述的同侧腓骨干带血管蒂肌肉移植在猴子和人类身上均已被证实是可行的。该骨干基于腓血管蒂以及腓骨肌和胫前肌掀起，为修复胫骨干的大缺损提供了一块优质的有活力骨支柱。朱代从大转子获取的股方肌带血管蒂移植已被证明在治疗股骨颈不愈合和股骨头缺血性坏死静止期方面优于菲米斯特的胫骨皮质骨或腓骨支柱移植。戴维斯和泰勒描述的取自髂前嵴的阔筋膜张肌带血管蒂移植为髋关节前路融合以及填充髋臼和股骨上段的缺损提供了一块优质的有活力骨支柱。附着于厚实臀肌蒂的整个大转子可用作髋关节融合的有活力关节外移植骨。罗斯等人以及布拉德福德所描述的基于肋间血管掀起的带蒂肋骨移植是用于矫正脊柱后凸和椎体感染性病变植骨的非常有用的有活力骨支柱。用于拇指再造的桡骨前臂皮瓣内的桡骨皮质骨移植、用于舟骨不愈合和月骨缺血性坏死的下桡骨旋前方肌带血管蒂移植以及用于横突间融合的后髂嵴竖脊肌带血管蒂移植都是需要进行评估以扩大临床应用范围的新概念。
