Jupiter J B, Gerhard H J, Guerrero J, Nunley J A, Levin L S
Massachusetts General Hospital, Boston 02114, USA.
J Bone Joint Surg Am. 1997 Apr;79(4):542-50. doi: 10.2106/00004623-199704000-00009.
Nine patients who had a complex, combined skeletal and soft-tissue defect involving the radius were managed with operative reconstruction with use of a vascularized osteoseptocutaneous fibular autogenous graft. All of the patients were male, and the average age was thirty-two years (range, twenty-one to forty-two years). Three patients sustained the injury as the result of a gunshot wound and two each, as the result of a motor-vehicle accident, a fall from a height, or a machinery-related accident. Five patients had a concomitant fracture of the ulna. The average length of the radial defect was seven centimeters. Six patients had a deep osseous infection. The average length of the fibular autogenous graft was 7.9 centimeters, and the average size of the associated fasciocutaneous component was 11.8 by 5.9 centimeters. Two patients had a concomitant arthrodesis of the wrist. A split-thickness skin graft was used to close the donor site in six patients. Two patients had postoperative vascular complications that necessitated revision with an autogenous vein graft. One patient had a second operation six months postoperatively to correct an angular deformity that had developed secondary to a non-union at the graft-host bone junction. After an average duration of follow-up of twenty-four months, all but one of the patients had radiographic evidence of osseous union at both the proximal and the distal graft-host bone junction. No patient had evidence of resorption of the graft or symptoms referable to the donor leg at the time of the most recent examination. Six patients had returned to their preinjury occupation.
9例患有涉及桡骨的复杂骨骼和软组织联合缺损的患者接受了带血管蒂骨膜皮瓣腓骨自体移植手术重建治疗。所有患者均为男性，平均年龄32岁（范围21至42岁）。3例患者因枪伤受伤，2例分别因机动车事故、高处坠落或机械相关事故受伤。5例患者伴有尺骨骨折。桡骨缺损的平均长度为7厘米。6例患者有深部骨感染。腓骨自体移植的平均长度为7.9厘米，相关筋膜皮瓣的平均尺寸为11.8×5.9厘米。2例患者同时进行了腕关节融合术。6例患者使用断层皮片移植来封闭供区。2例患者术后出现血管并发症，需要用自体静脉移植进行修复。1例患者在术后6个月进行了第二次手术，以纠正因移植骨与宿主骨交界处骨不连而出现的角形畸形。平均随访24个月后，除1例患者外，所有患者在移植骨与宿主骨交界处的近端和远端均有影像学证据显示骨愈合。在最近一次检查时，没有患者有移植骨吸收的证据或供肢相关症状。6例患者已恢复伤前工作。
