Malizos K N, Nunley J A, Goldner R D, Urbaniak J R, Harrelson J M
Orthopaedic Surgery Department, Duke University Medical Center, Durham, North Carolina 27710.
Microsurgery. 1993;14(6):368-74. doi: 10.1002/micr.1920140603.
In this retrospective analysis, we present our experience with two groups of patients who had long bone defects secondary to trauma or tumor resection and who were treated with a free vascularized fibular graft for skeletal reconstruction. Both groups were comparable in number and average age of patients, length of bone defect, and mean follow-up (average 3 years both groups). The number of surgical procedures prior to microvascular grafting was significantly higher for the traumatic defects. Primary bone union in a mean period of 6 months occurred at a higher rate in the tumor patients; the trauma patients had a significantly higher nonunion rate, which required multiple additional surgical procedures. The latter did not, significantly, improve the rate of success in the trauma group. Residual limb shortening was present in one-half of the patients with traumatic defects. On the basis of this review, it appears that the scarred and relatively avascular soft tissues surrounding the long bone defects secondary to trauma affect the course and the final outcome of the microvascular fibular grafting. A similar procedure applied for limb salvaging after tumor resection is better.
在这项回顾性分析中，我们介绍了两组患者的治疗经验，这两组患者均因创伤或肿瘤切除导致长骨缺损，并接受了游离带血管腓骨移植进行骨骼重建。两组在患者数量、平均年龄、骨缺损长度和平均随访时间（两组均为平均3年）方面具有可比性。创伤性缺损患者在微血管移植前的手术次数显著更多。肿瘤患者在平均6个月的时间内实现一期骨愈合的比例更高；创伤患者的骨不连发生率显著更高，这需要多次额外的手术。后者并未显著提高创伤组的成功率。创伤性缺损患者中有一半存在肢体残余缩短。基于这项综述，继发于创伤的长骨缺损周围瘢痕化且相对无血管的软组织似乎会影响微血管腓骨移植的进程和最终结果。类似的用于肿瘤切除后保肢的手术效果更好。
