大段复合骨修复四肢骨缺损携带监测皮岛的临床意义

目的探讨大段复合骨移植修复四肢大段骨缺损中设计携带监测皮岛的临床意义。方法自2001年1月至2004年12月,采用带3 cm×5 cm监测皮岛的自体腓骨干或腓骨近段与大段异体骨开槽捆绑或嵌套式复合骨移植修复四肢大段骨缺损19例,骨缺损长度12～25 cm,平均16．6 cm；移植的自体腓骨15～28 cm,平均18．3 cm。术后1周内连续观察监测皮岛的颜色、温度、弹性、毛细血管充盈等指标,定期影像学观察、评价大段复合骨移植骨愈合情况。结果监测皮岛能准确了解移植腓骨的血供。其中,监测皮岛显示静脉危象1例,经手术探查取出吻合口血栓后皮岛及移植腓骨血管危象解除；其余监测皮岛正常。经6～54个月(平均23．2个月)随访,全部监测皮岛存活并与周围皮肤正常愈合。15例在术后3个月即有异体骨与自体骨影像学骨性愈合。术后超过1年并已拆除内固定的共有11例,术中证实异体骨与自体骨间已骨性愈合。结论在大段复合骨移植中设计携带监测皮岛,有助于了解移植腓骨的血供和早期预测大段复合骨的转归。

Clinical significance of monitoring-flap in massive compound bone grafts for repairing massive bone defects in extremities

Objective To explore the significance of designing with monitoring-flap in massive com- pound bone grafts for repairing massive bone defects in extremities.Methods From January 2001 to De- cember 2004,large bone defects in 19 patients(11 men and 8 women,age:6 to 35 years,mean age:18.6 years)were repaired by vascularized free fibular transplant with a monitoring-flap combining with massive deep frozen bone allografts.Average length of the bone defects was 16.6 cm(range,12 to 25 cm).A 7 days' con- tinuously clinical examination including observing the color,turgor,temperature,capillary refill,and bleeding after a needle sticking of the monitoring-falps were used postoperatively,if any one of these were abnormal,the circulation of the compound bone grafts must be in danger and some measures such as re-operation should be taken immediately.Dynamic image analysis was used for evaluating the bone union.Results One monito- ring-flap was vascular artieulo,and the articulo was relieved after exploration and resection of vein thrombus; another one was marginal part necrosis;the remains were normal.All of monitoring-flaps healed normally after 23.2 months(range,6 to 54 months)follow-up.15 patients had the radiographic evidence of bone unions 3 months after surgery.11 patients had been removed intermal fixation,complete bone unios were found one year postoperatively.Conclusion Designing with monitoring-flap in massive compound bone grafts for repairing massive bone defects,and can clearly understand the circulatory statue of compound bone grafts and early pre- dict the final results of massive bone allografts.