带血管骨移植在四肢骨肿瘤治疗中的应用

目的临床观察带血管骨移植修复四肢骨肿瘤瘤段切除后骨缺损的治疗价值。方法对４８例不同类型的骨肿瘤行局部彻底切刮除，或骨膜外瘤段切除后所致的骨缺损分别采用带血管蒂髂骨瓣转位移植６例，游离移植３例；带血管胫骨瓣游离移植１例；带血管蒂腓骨瓣同侧顺逆行转位移植９例，游离腓骨移植２２例，双腓骨瓣组合移植４例，腓骨皮瓣游离移植３例进行修复治疗。结果移植骨与主骨均获得愈合，时间为２５～４２个月，平均３５个月。并经０５～１２年（平均４７年）的随访，４５例治愈，；３例复发，复发的３例病人中２例为骨肉瘤，１例为动脉瘤样骨囊肿恶性变，最终行了截肢术。结论证明带血管骨移植用于修复病变广泛的良性骨肿瘤或低变恶性骨肿瘤瘤段切除后的骨缺损疗效可靠，恶性肿瘤者较差。

Vascularized Bone Transplantation in Treatment of Bone Tumors in Extrimities

Objective To observe clinically on the therapeutic value of vascularized bone transplantation in the repair of osseous defects in extremities after removal of bone tumors. Methods After excision of local tumor or extraperiosteal tumor from 48 patients with various kinds of bone tumors,the osseous defects were treated with vascular pedicle iliac flap transposition grafting in 6 cases,and free iliac grafting in 3;with free vascularized tibial flap grafting in 1;with vascular pedicle fibular flap transposition grafting in 9,and free fibular grafting in 22,combined doublefibular flap grafting in 4,and free fibular skin flap grafting in 3. Results The grafted and host bones were union with a healingtime range of 2542 months(35 months in average).In followingup for 0512 years,there were 45 cases cured and 3 cases recurred.The 3 recurrent cases,including 2 cases of osteosarcoma and one of malignant change of aneurysmlike bone cyst,received amputations at last. Conclusion It was demonstrated that vascularized bone grafting is reliable for repairing osseous defect after excision of benign or lower malignant osseous tumor but not good for the malignant.