Doi K, Sakai K
Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Japan.
Microsurgery. 1994;15(5):305-15. doi: 10.1002/micr.1920150505.
Free, vascularized thin corticoperiosteal grafts and small periosteal bone grafts harvested from the supracondylar region of the femur are described. These grafts are nourished from the articular branch of the descending genicular artery and vein. Thin corticoperiosteal grafts consist of periosteum with a thin layer of outer cortical bone and include the cambium layer, which has a better osteogenic capacity. This graft is elastic and readily conforms to the recipient bed configuration. Thin corticoperiosteal grafts were used to treat 11 patients with fracture non-union of an upper extremity that had no massive bone defects. Early, rapid union occurred in all patients except three: one in which the anastomosed vessel became obstructed and two in which the internal fixation of the fracture was unsecured. The small bone grafts consist of periosteum, full thickness cortex, and the underlying cancellous bone. This graft can be successfully harvested without disturbing the vascularity, unlike the currently used vascularized bone grafts. This graft was used to treat three patients with avascular necrosis of the body of the talus and could prevent the necrotic talus body from progressive collapse in patients in early stages of the disease. One patient with an infectious bone defect of the first metatarsal bone was successfully treated by vascularized bone graft with an accompanying skin flap.
本文描述了从股骨髁上区域获取的游离、带血管的薄皮质骨膜移植物和小骨膜骨移植物。这些移植物由膝降动脉和静脉的关节支供血。薄皮质骨膜移植物由骨膜和一层薄的外层皮质骨组成，包括具有更好成骨能力的生发层。这种移植物具有弹性，能很容易地贴合受区床的形态。薄皮质骨膜移植物用于治疗11例无大块骨缺损的上肢骨折不愈合患者。除3例患者外，所有患者均早期快速愈合：1例吻合血管阻塞，2例骨折内固定不牢固。小骨移植物由骨膜、全层皮质骨和下方的松质骨组成。与目前使用的带血管骨移植物不同，这种移植物可以在不干扰血运的情况下成功获取。这种移植物用于治疗3例距骨体缺血性坏死患者，在疾病早期可防止坏死的距骨体逐渐塌陷。1例第一跖骨感染性骨缺损患者通过带血管骨移植物联合皮瓣成功治愈。
