不同类型血管蒂胫骨皮瓣治疗四肢骨不连

目的探讨采用不同类型血管为蒂胫骨皮瓣修复四肢骨不连的临床效果。方法 2004年6月至2018年10月,对41例四肢不同类型骨不连或伴有皮肤软组织缺损者,分别采用以单纯胫后血管束为蒂的桥式交叉胫骨皮瓣5例,以胫后动脉穿支为蒂的桥式交叉胫骨皮瓣修复9例、游离移植27例。切取胫骨瓣长度为1.0～8.0 cm,切取皮瓣面积为2.5 cm×2.0 cm～8.0 cm×25.0 cm。术后对所有患者均进行常规X线片随访,直至骨质愈合。结果术后对所有患者均进行随访。胫骨骨皮瓣全部成活,随访3～24个月,骨不连、骨缺损修复后,骨愈合良好,3～8个月骨折线消失。其中,27例皮瓣与修复区周围组织基本相平,14例有不同程度臃肿,经二期去脂整形手术后,也与周围组织平齐。19例掌骨或指骨骨不连的患者,术后按照中华医学会手外科学分会上肢部分功能评定试用标准中TAM系统评定法进行关节功能评定:优11例,良6例,可2例。22例胫骨骨不连的患者,术后恢复负重行走功能。结论三种不同类型血管为蒂胫骨皮瓣修复四肢骨不连均取得很好的治疗效果,其各有优缺点,又相互补充,是一类较为可行的骨不连修复方法。

Tibia skin flap based on the different types of blood vessels for treatment of bone nonunion in extremities

Objective To investigate the clinical application effect of the tibia skin flap based on the different types of blood vessels for treatment of bone nonunion in extremities. Methods From June 2004 to October 2018, a total of 41 patients of different types of bone nonunion or skin and soft tissue defects were treated. Five patients were treated with the bridge mode transfer of pedicle tibia skin flap based on the simple posterior tibial vascular bundle, 9 patients were treated with the bridge mode transfer of pedicle tibia skin flap based on the perforator of the contralateral posterior tibial artery, and 27 patients were treated with the free tibia skin flap based on the perforator of the posterior tibial artery. The length of the tibial flap ranged from 1.0 to 8.0 cm, and the size of cutaneous flaps ranged from 2.5 cm×2.0 cm to 8.0 cm×25.0 cm. All patients were followed up after surgery. All patients were followed up until the healing phase was complete. Results All the tibia skin flap survived. Followed up for 3 to 24 months, after the repair of nonunion and defect, the bone healed well and the fracture line disappeared after 3 to 8 months. 27 cases of all skin flaps were flat with the surrounding skin tissue and the others bloated, but they had the same effect after second phase to fat plastic. According to the related evaluation criteria made by the Chinese Medical Association, the results of 19 patients with nonunion of metacarpal or phalanx were excellent in 11 cases, good in 6 cases, fair in 2 cases. 22 cases of lower leg patients could walk with load. Conclusion The tibia skin flaps based on the different types of blood vessels are ideal methods to treat the bone nonunion in extremities. They have advantages and disadvantages, and complements each other. The tibia skin flaps are kinds of feasible method to repair bone nonunion.