四种不同类型带血供腓骨移植的临床应用

作者分别采用膝下外血管，腓血管为蒂的游离腓骨移植和以腓动为蒂的排骨须行或逆行转位移植，治疗１３例炎症、肿瘤、先天性形造血的尺桡骨（包括骨骺）缺损。结果：以膝下外血管为蒂的腓骨上段骨（骨骺）移植，修复桡骨远端缺损，重建桡腕关节疗效满意，１例骨骺移植，获较好的继续生长，随访３年，与对侧等长，以腓动脉为蒂的腓骨干移植，无论是游离或转位移植，用于修复长度〉６ｃｍ的长骨缺损疗效满意。     

带血供腓骨小头骨骺移植的解剖与临床研究

目的 观察腓骨小头骨骺的血供来源及带血供腓骨小头骨骺移植治疗骨骺损伤的效果。方法 5具10侧足月新生儿尸体的下肢标本。对腓骨头的营养血管进行显微解剖观察。本组共6例患者,平均年龄9岁,胫骨近端内侧骨骺骨桥形成1例,胫骨远端骨骺骨桥形成伴踝关节畸形3例。股骨头骨骺陈旧性滑脱1例,股骨头缺血性坏死1例,应用带膝下外血管的腓骨小头骨骺移植进行修复。结果 膝下外动脉、胫前返动脉、旋腓动脉的分支在腓骨小头的表面形成广泛血管吻合,营养腓骨小头骨骺。以膝下外动脉为蒂的腓骨头骨骺移植,血供丰富。经术后平均2年6个月的观察,5例移植骨骺生长良好,1例因术后感染,移植物部分吸收且骺板闭合。结论 以膝下外血管为蒂的腓骨骨骺游离移植,适合于长骨骨骺损伤的修复。     

膝下外血管为蒂腓骨上段骨(骺)瓣移植

以腓血管为蒂或不带血管蒂游离腓骨移植重建肩关节或桡腕关节已在临床广泛应用，但前者修复肱桡骨较短缺损有血供不足之虞，后者不带血供是其明显缺点。陈振光〔１〕１９９０年首次报道了膝下外血管为蒂的腓骨上段移植，临床应用取得成功，但目前文献仍报道较少。我们从９...     

桡骨远端骨缺损的修复与功能重建

对于桡骨远端骨缺损的治疗包括修复骨缺损及重建腕关节功能。自１９７９年以来，采用了吻合腓血管的腓骨移植，吻合膝下外血管的腓骨上段骨瓣移植及带血管蒂的肩胛骨瓣移植修复桡骨远端骨缺损，并重建腕关节功能共１３例，经１年～１０年随访，获得了较满意的效果。对桡骨中、远端骨病损后长段骨缺损的修复、术式、手术注意事项及适应证等的选择进行了讨论。认为，应根据骨缺损的长短，分别选用吻合腓血管的腓骨移植或吻合膝下外血管的腓骨上段骨瓣移植来修复骨缺损，并重建腕关节功能。     

同侧带血管的腓骨移植的几种方法探讨

本文报告了自1984年以来应用同侧带血管的腓骨移植修复胫骨大段缺损8例,均在3～5月骨性愈合。其中急诊同侧腓骨移植5例。4例为以腓血管远端为蒂的逆行腓骨移植,3例为以腓血管近端为蒂的腓骨转位,1例吻合血管的腓骨移植。2例应用同侧     

带血管蒂骨骺瓣移植的基础与临床研究

目的介绍带血管蒂骨骺瓣移植的基础研究及相关临床应用。方法回顾总结笔者近20年来在带血管蒂骨骺瓣移植方面所做的相关应用解剖、动物实验及临床应用研究,探讨其临床应用疗效。结果膝下外侧动脉腓骨头骺瓣和臀上动脉深上支髂骨骺瓣均可作为骨骺游离移植的供区。动物实验表明,带血供的骨骺瓣移植能够成活并保持生长能力。1例膝下外侧动脉腓骨头骺瓣移植重建尺骨远端患者,18年随访示修复的尺骨与对侧几近等长且功能良好。结论带血管蒂骨骺瓣移植是修复儿童长骨骨端缺损的有效方法。     

组织瓣移植在修复重建外科的应用

创伤、炎症、肿瘤造成的组织缺损,临床上非常多见,是修复重建外科中需要加以解决的一大难题。我们从1991年以来,应用显微外科技术,采用皮瓣、肌瓣、骨瓣移植,修复各类不同部位的组织缺损或拇指再造47例,经6月～5年随访,效果满意,报道如下。临床资料本组男30例,女17例。年龄3～48岁。皮瓣面积2cm×5cm～20cm×25cm,腓骨切取最长7cm。包括(1)腓深血管蒂的组织瓣14例,其中带蒂移位12例,吻合血管游离移植2例;(2)腓浅血管蒂皮瓣1例;(3)胫后动脉静脉蒂小腿内侧皮瓣逆行转位2例;(4)腓肠肌皮瓣岛状转移6例;(5)骨间背血管为蒂的前臂背侧皮瓣2例;(6)胸…     

吻合血管的骨移植及钛板内固定修复下颌骨缺损

目的 探讨吻合血管的游离髂骨或腓骨移植及钛板坚强内固定在修复下颌骨缺损中的临床应用效果。方法 选择7例以旋髂深动静脉为蒂的游离髂骨肌瓣和2例以腓动静脉为蒂的游离腓骨肌瓣修复9例下颌骨缺损，并用钛板坚强内固定，血管的动静脉蒂分别与颌外动静脉吻合。结果 9例术后2～4周经放射性核素锝亚甲基二磷酸盐(^99mTc MDP)扫描证实血供良好，移植骨成活。经6个月至3年随访，移植骨固位稳定。结论 吻合血管的骨移植及钛板内固定是修复下颌骨缺损的最佳选择之一。     

腓侧皮瓣的临床应用

以腓动脉及其皮支或肌皮支为血管蒂,采取小腿外侧皮瓣称腓侧皮瓣。吉村光生氏等1984年7月首先报告应用该岛状皮瓣及游离皮瓣修复四肢软组织缺损。 作者报告应用5例。其中,游离腓骨移植治疗先天性胫骨假关节2例,治疗下颌骨癌     

以腓动脉肌皮支为蒂的小腿外侧皮瓣修复手部创面

自顾玉东等(1985)以腓动脉为血管蒂的小腿外侧皮瓣修复软组织缺损以来,该皮瓣在临床已得到一定应用.由于切取该皮瓣体位不舒适,需牺牲下肢一条主要动脉,偶有胫后动脉、腓动脉共干,限制了该皮瓣的临床应用.我院1996年10月～2002年12月,采用逆行法解剖分离以腓动脉肌皮支为血管蒂的小腿外侧皮瓣游离移植修复手部创面19例,疗效满意,报告如下.     

采用带血管腓骨移植一期修复慢性骨髓炎大段骨缺损

目的 探索慢性骨髓炎大段骨早期摘除后骨缺损的一期修复效果。方法 胫骨慢性骨髓炎并大段骨清除后,作吻合血管腓骨移植一期予以重建１８例;作炎性骨段切除,采肜带血管蒂腓骨移位一期予以修复２例。结果 胫骨慢性骨髓炎在摘除在大段死骨后应用吻合血管腓骨移植或带血管腓骨移植或带血管蒂腓骨移位重建。术后３￣６个月见重建骨完全骨性愈合,邻近关节诸骨受累的炎症得到完全控制;修复肢体的功能与外形恢复令人满意。结论 对慢     

Reconstruction of large posttraumatic skeletal defects of the forearm by vascularized free fibular graft

Vascularized bone graft is most commonly applied for reconstruction of the lower extremity; indications for its use in the reconstruction of the upper extremity have expanded in recent years. Between 1993-2000, 12 patients with segmental bone defects following forearm trauma were managed with vascularized fibular grafts: 6 males and 6 females, aged 39 years on average (range, 16-65 years). The reconstructed site was the radius in 8 patients and the ulna in 4. The length of bone defect ranged from 6-13 cm. In 4 cases, the fibular graft was harvested and used as a vascularized fibula osteoseptocutaneous flap. To achieve fixation of the grafted fibula, plates were used in 10 cases, and screws and Kirschner wires in 2. In the latter 2 cases, an external skeletal fixator was applied to ensure immobilization of the extremity. The follow-up period ranged from 10-93 months. Eleven grafts were successful. The mean period to obtain radiographic bone union was 4.8 months (range, 2.5-8 months). Fibular grafts allow the use of a segment of diaphyseal bone which is structurally similar to the radius and ulna and of sufficient length to reconstruct most skeletal defects of the forearm. The vascularized fibular graft is indicated in patients with intractable nonunions where conventional bone grafting has failed or large bone defects, exceeding 6 cm, are observed in the radius or ulna.     

Free vascularized fibula grafts in surgery of the upper limb

Twenty patients with intractable diseases in the upper extremity were treated using free vascularized fibula grafts. There were 13 men and seven women. Three patients had traumatic bone defects, five had post-traumatic nonunions, two had congenital pseudoarthroses, seven had defects after tumor resection, and three had other lesions. The reconstructed sites were the humerus in two patients, the radius and/or ulna in 17, and the metacarpal and phalangeal bones in one. The length of the bone defect ranged from 3 to 18 cm (mean: 8.4 cm). Follow-up periods ranged from 6 to 204 months. No patient required additional bone grafts. The mean period required to obtain radiographic bone union was 4.4 months. There were no cases with fractures of the grafted bone, but malunion occurred in four cases. The vascularized fibula graft is indicated in patients with large bone defects or intractable nonunions in the humerus, radius, and/or ulna.     

吻合血管腓骨移植的新术式

目的 探索扩大吻合血管腓骨移植修复骨缺损的应用范围。方法 应用吻合血管节段性腓骨移植修复骨肿瘤切除后骨缺损;吻合口管双节段腓骨或复合组织瓣移植－期修复尺,桡骨缺损;对于Ⅲ度胫骨粉碎性骨折,采用带血管或吻合血管腓骨移植,起到内夹板固定作用,并加速骨折的愈合。结果 所有被修复骨缺损均获良好愈合,其功能与外形均令人满意。结论 以上术式的开展,扩大了吻合血管腓骨移植的应用范围,为腓骨移植展示了良好的临床应     

吻合血管的近段腓骨移植重建肩腕关节

目的 探讨带血管蒂的近段腓骨移植重建肩、腕关节炎的疗效。方法 对近端肱骨和桡骨远端骨巨细胞瘤病例彻底切除瘤段骨及周围反应组织,采用带血管蒂的游离近段腓骨移植重建肩关节和腕关节。结果 经术后6个月－2年随访,2例重建肩、腕关节外观和功能恢复良好,肿瘤无复发。结论 带血管蒂近段腓骨移植是治疗肱骨近端和桡骨远端肿瘤切除后骨缺损和重建肩、腕关节的理想方法。     

Assessment of vascularized fibular graft one year after reconstruction of the wrist after excision of a giant-cell tumour.

We report a patient in whom the distal radius was resected for a giant cell tumour and the bone defect was replaced using a vascularized proximal fibular graft. The graft was viable and hypertrophied and normal callus formed on the distal radius. Due to chronic instability of the wrist the patient underwent revision arthrodesis 1 year after resection. Microscopic studies of the epishyseal region of the fibula showed wide necrosis of the graft with active creeping substitution. Despite the good technical result of the vascularized fibular graft, the vascularization was incomplete in the proximal epiphysis. We discuss possible reasons for this.     

A solution to the vessel shortage during free vascularized fibular grafting for reconstructing infected bone defects of the femur: Bridging with vein transplantation

PurposeThe present study aimed to evaluate the feasibility and clinical efficacy of bridging vein transplantation to deal with the vessel shortage during free vascularized fibular grafting for reconstructing infected bone defects of the femur.MethodsTwelve patients (aged 15–58 years) with infected bone defects of the femur (between 6.0 and 18.0 cm) were recruited in this study. Vacuum sealing drainage were applied after extensive debridement of the infected bone defects and irrigated with 0.9% sodium chloride solution for 1–2 weeks. After the drainage was clear and the focal infections were controlled, the free vascularized fibula was harvested for reconstructing the femoral bone defects. The vascularized fibula was grafted and fixated appropriately at the recipient site. The autogenous great saphenous vein was harvested, one end was anastomosed and bridged the vascular pedicles of the fibular grafts, and the other end anastomosed the artery and/or the vein in the recipient healthy site.ResultsMean length of vein transplantation with vascularized fibular graft was 10.2 cm (range 7–15 cm). All patients had good radiological healing without recorded nonunion or malunion. No patient developed deep infection or implant failure. Primary bone healing was achieved in 10 patients; however, 2 grafted fibular formed pseudarthrosis with the recipient femoral and then healed after a secondary surgery. One patient suffered from graft stress fracture after bone healing and healed after external fixation. After the mean follow-up of 30 months (9–72 months), according to the Enneking scoring system, clinical outcomes were excellent in 7 patients, good in 4 and fair in one. The functional recovery rate of the lesion limb was 89.4%.ConclusionsFree vascularized fibular graft with vein transplantation bridged vascular pedicle can effectively repair the infected bone, improve blood supply to the bone defect site, and help control infection. It is a feasible and effective treatment for infected bone defects of the femur with poor soft tissue conditions, or blood supply vessel shortage.     

带血管蒂骨膜瓣移位修复肱骨骨不连的解剖与临床研究

目的：探讨带不同血管蒂骨膜瓣移位修复肱骨骨不连的应用价值。方法：通过对旋肱前血管内、外侧降支、肱血管肌间隙支,桡侧副血管和骨间返血管的应用解剖学研究,创用了以上述血管为蒂的骨膜瓣移位术,并总结临床应用情况。结果：临床施术36例,效果满意。上述5种骨膜瓣移位术均各有其适用范围。结论：旋肱前血管外侧降支肱骨上段骨膜瓣适于修复肱骨近端;旋肱前血管内侧降支肱骨中段骨膜瓣是修复肱骨上段的理想供区,肱血管肌间隙支肱骨中段骨膜瓣供修复肱骨中下段,桡侧副血管肱骨下段骨膜瓣适于修复肱骨中段或中下段;骨间返血管尺骨上段骨膜瓣逆转移位则用于修复肱骨下段髁上部。     

Vascularized bone grafts to the upper extremity. Indications and technique.

Massive autogenous bone grafts with an intact vascular pedicle decrease the time to bony union and immobilization required for treatment of segmental bony defects. These techniques have been shown to be effective in treatment of segmental defects of more than 6 cm after trauma or tumor resection in relatively avascular beds. Additionally, in the upper extremity, the free vascularized bone graft is in the developmental phase for employment in the reconstruction of epiphyseal arrest and congenital radial club hand. There are disadvantages to free vascularized bone transfers compared with conventional techniques. For example, a free vascularized fibular transfer requires a team skilled in microvascular technique, a long operative time (6 to 10 hours), and the sacrifice of a major vessel to the lower extremity. If the anastomosis fails, however, the free vascularized fibula will act as a conventional bone graft, thereby minimizing adverse effects. We think that by proper patient selection, appropriate evaluation and preparation of the bony defect, meticulous microvascular anastomosis, and correct fixation and immobilization of the graft a good outcome can be achieved in those patients with large bony defects that defy the use of conventional methods.