自体骨髓移植对吻合血管的移植腓骨形态改变的影响

目的 探讨经皮向体骨髓移值对吻合血管的移植腓骨形态改变和愈合速度的影响。方法 吻合血管的腓骨移植修复23例小腿胫骨缺损随机选取10例，术后4周，由髂前上棘抽取的自体骨髓经皮穿刺，移植注入移植腓骨两端和散在多点移植腓骨的骨膜周嘲及肌袖内，隔6周和12周后分别再两次注入自体骨髓。结果 自体吻合血管的腓骨-骨髓复合移植与单纯自体吻合血管的腓骨移植修复小腿胫骨缺损相比，自体吻合血管的腓骨-骨髓复合移植的移植腓骨骨愈合时间明显缩短，平均随访时间内移植腓骨的形态增粗率也明显增加。结论 自体骨髓移植是促进吻合血管的移植腓骨骨愈合和加速其形态增粗率较有效的方法。     

血管襻骨膜内组合腓骨同蒂皮瓣移植修复骨与皮肤缺损

目的 探讨下肢粗骨长段缺损与皮肤缺损同时修复的可行方法。方法 将腓血管制成1个或2个血管襻，该血管襻携带皮瓣，再将多段腓骨于骨膜内组合在一起，使成为一个骨膜包裹的粗骨修复骨与皮肤缺损。有丰富血运的骨膜，其骨膜下新生骨活跃，该新生骨充填骨膜内与腓骨段问隙、包绕腓骨，使移植腓骨增粗。结果 临床应用30例，所携带的皮瓣血运良好，伤口一期愈合。1年后骨折愈合，2年后移植骨增粗，能负重行走，移植骨无骨折。供腓骨侧踝关节稳定，伸屈范围正常，功能恢复正常。结论 血管襻骨膜内组合腓骨同蒂皮瓣移植是修复粗骨与皮肤缺损的一种可行方法。     

血管襻骨膜内组合腓骨同蒂皮瓣移植修复骨与皮肤缺损

目的 探讨下肢粗骨长段缺损与皮肤缺损同时修复的可行方法。方法 将腓血管制成1个或2个血管襻，该血管襻携带皮瓣，再将多段腓骨于骨膜内组合在一起，他成为一个骨膜包裹的粗骨修复骨与皮肤缺损。有丰富血运的骨膜，其骨膜下新生骨活跃，该新生骨充填骨膜内与腓骨段间隙、包绕腓骨，使移植腓骨增粗。结果 临床应用5例，所携带的皮瓣血运良好，伤口一期愈合。1年后骨折愈合，2年后移植骨增粗，能负重行走，移植骨无骨折。供腓骨侧踝关节稳定．伸屈范围正常，功能恢复正常，结论 血管襻骨膜内组合腓骨同蒂皮瓣移植是修复粗骨与皮肤缺损的一种可行方法。     

吻合血管的腓骨移植加单纯腓骨植骨修复肿瘤性长段股骨干缺损

目的 报道吻合血管的腓骨移植加单纯腓骨植骨在肿瘤性长段股骨干缺损修复中的应用效果.方法 对肿瘤性长段股骨干骨缺损采用吻合血管的腓骨移植加单纯腓骨植骨并辅以外固定支架固定手术修复37例,按Enneking分期原则确定切除范围,进行瘤段广泛切除,高恶性骨肿瘤则进行手术前、后化疗.结果 术后随访1～12年,移植骨生长良好,能完全负重,治疗满意率为84%.主要并发症是:外固定支架钉道感染、踝关节疼痛、移植腓骨骨折等,其发生率为8.1%;局部复发及肺转移6例,5年以上带瘤生存4例.恶性肿瘤的保肢率为76%.结论 应用吻合血管的腓骨移植加单纯腓骨植骨治疗肿瘤性股骨干长段骨缺损可获得较好的治疗效果.     

血管长段桥接腓骨皮瓣修复小腿皮肤软组织及骨缺损

目的：探讨血管长段桥接加健侧腓骨骨皮瓣移植修复小腿皮肤软组织缺损并骨缺损的疗效。方法：应用血管长段桥接腓骨骨皮瓣移植术一次修复小腿皮肤软组织缺损并骨缺损8例，其中4例伴有胫前血管和腓血管同时损伤，4例仅伴有胫前血管损伤，骨皮瓣血管蒂腓动脉长段桥接后与股动脉端侧吻合或与股动脉分支端端吻合，腓静脉与大隐静脉直接端端吻合或血管桥接后端端吻合。结果：8例全部成活，随访半年－2年4个月，骨皮瓣质地良好，X线片复查示移植腓骨与胫骨一期愈合且不同程度增粗，患者可从事轻体力劳动。结论：血管长段桥接腓骨骨皮瓣移植修复小腿皮肤软组织缺损并骨缺损，疗程短，效果好，是解决受区无可供血管吻合时的一种有效方法。     

吻合血管折叠式腓骨皮瓣修复大段胫骨及皮肤软组织缺损

目的报道采用吻合血管的折叠式腓骨皮瓣修复胫骨大段缺损伴骨外露的方法，并观察其临床疗效。方法采用吻合血管的折叠式腓骨皮瓣修复胫骨大段缺损伴骨外露5例。胫骨缺损6～10cm，皮肤软组织缺损范围4cm×5cm-7cm×18cm。保持骨膜的连续性，将腓骨截骨后折叠形成双管状腓骨皮瓣，移植修复胫骨及皮肤缺损。结果术后移植组织全部成活，皮瓣弹性、色泽良好，术后3—4个月患肢开始负重，术后随访8～10个月，复查X线片示腓骨与胫骨骨性愈合良好，恢复行走功能。结论吻合血管的折叠式腓骨皮瓣修复胫骨大段缺损伴骨外露及皮肤软组织缺损是可靠、有效的治疗方法，值得临床推广应用。     

吻合血管游离双侧腓骨组合移植修复股骨大段缺损

目的 报道应用吻合血管双侧游离腓骨组合移植修复股骨节段性缺损的技术和效果。方法 在1984年10月～1992年5月间，应用吻合血管游离移植双侧腓骨治疗了股骨缺损9例，其中5例为骨肿瘤，3例为慢性骨髓炎后病理性骨折，1例为创伤性骨缺损。移植腓骨长12～22cm，平均16．25cm。结果 除1例术后6个月因软骨肉瘤复发而截肢外，移植腓骨均于术后3～6个月与宿主骨牢固连接，患肢术后3～7个月开始负重。结论 吻合血管双侧游离腓骨组合移植修复10cm以上股骨缺损，疗程短，效果好，是个可供选择的治疗方法。     

游离腓骨移植修复股骨下段缺损

游离腓骨移植修复股骨下段缺损周围，牟宇科，邓万祥，赵胡瑞，周广恒１９９０年４月以来，我院对２例股骨下段骨缺损患者采用同侧腓骨游离移植，腔后动脉游离后逆转与腓动脉吻合方法修复，获满意疗效。１病例介绍例１男，５岁。１９９１年７月因左股骨下段骨髓炎至股骨缺...     

带血运骨膜内组合双段腓骨移植治疗下肢长骨骨纤维结构不良致大段骨缺损

目的 探讨下肢长骨大段骨纤维结构不良切除后骨缺损的修复方法.方法 1995年5月至2003年8月,6例骨纤维结构不良患者.男5例,女1例.年龄14～40岁(平均25.5岁).胫骨干2例,股骨干4例.肿瘤切除后骨缺损的长度为15～22 cm.移植双腓骨段长度17～24 cm.均从双侧切取带腓血管的腓骨,在一端将腓血管吻合,使成一条腓血管相连的双段腓骨.将双段腓骨的前内侧骨膜从中央纵行切开并向两侧剥离至骨嵴.双段腓骨折叠,其前内侧面相对,两断端同定,将相对缘游离的骨膜纵行缝合,使其组合为一个骨膜包裹的粗骨.将与双段腓骨相连的腓血管襻在移植体一端制成"U"形,勿形成锐角.能保证血管供血不受影响.解剖出受区血管.将组合的腓骨插入骨折两断端间,如不稳定,加用钢丝或螺钉固定.精确无误地将腓血管与受区血管进行吻合,通过移植体骨膜出血情况判断血管吻合口情况.结果 随访6～10年,平均7.4年.1年后骨性愈合;5年后5例移植骨髓腔再通.移植的双腓骨未发生肿瘤,X线片显示为正常骨骼;1例股骨干于正常骨干远段复发,但移植骨部分未复发.骨移植体愈合好,无发生骨不连、骨感染等并发症.膝关节伸屈功能恢复正常,逐渐恢复日常活动与工作.结论 骨膜内组合双腓骨移植足修复下肢长骨大段缺损的良好方法 .     

有血运骨膜内组合的双段腓骨移植修复负重长段粗骨缺损

目的探讨骨膜内组合双腓骨移植修复长管负重骨缺损的方法。方法将吻合血管的双腓骨或双段腓骨的前内侧骨膜从中央纵行切开并向两侧剥离至骨嵴，双腓骨或双段腓骨折叠，其前内侧面相对，两断端固定，将相对缘游离的骨膜纵行缝合，使其组合为一个骨膜包裹的粗骨，修复骨缺损。结果34例长管负重骨缺损均获得良好骨愈合，移植骨无折断。结论骨膜内组合双腓骨移植是修复长管负重骨缺损的良好方法。     

Salvage of the lower leg using a reversed long free fibular flap

The advantages of end-to-side anastomoses have been well documented in microvascular surgery. The vessels of the fibular flap do not usually permit end-to-side anastomosis to recipient vessels in the proximal part of the lower leg because the pedicle length of the free fibular flap is usually too short. Therefore, vein grafts are used to elongate the vessels. If a harvested long free fibular flap that is used to bridge a massive defect of the tibia is reversed and placed into the medullary cavity of the tibia, the flap vessels can be anastomosed, using the end-to-side technique, to the recipient vessels without vein grafts in the distal part of the lower leg. Thus, the flap artery (the peroneal artery) fills in a retrograde fashion. The patient reported was reconstructed with a reversed long free fibular flap. The postoperative period was uneventful. The patient can stand and walk with a protective shoe 2 years postoperatively.     

Intramedullary fibular graft for supracondylar fracture of the femur following total knee arthroplasty

We describe a successful treatment, intramedullary fibular grafting, for a patient with a supracondylar fracture of the femur following total knee arthroplasty in which the fracture region was comminuted and a segmental large bone defect was present. Free autogenous fibular was inserted into the medullary cavity from the intercondylar region and fixed to the proximal fragment of the femur with augmented fixation using a small plate and screws. Our procedure makes it easy to perform large segmental bone grafting and internal fixation at the same time for such a condition.     

成人双腓骨游离移植修复股骨远端巨大骨缺损

目的探讨不同原因所致股骨远端巨大骨缺损的治疗手段及疗效. 方法 1998年2月～2002年12月对6例患者(年龄19～37岁)股骨下端骨肿瘤切除术后、骨髓炎及外伤性骨缺损,采用吻合血管的双腓骨移植,在股骨远端及胫骨关节面切除后植骨,以螺钉固定,两腓骨相对侧骨膜切开,骨皮质紧贴并缝合骨膜. 结果术后获随访13个月～5年7个月,平均3年4个月,移植骨生长良好,能完全负重,其中1例随访至5年7个月时X线片见双腓骨骨皮质之间完全愈合,并显示双腓骨出现髓腔再通,融为一个髓腔,且负重能力更强. 结论股骨下端骨缺损用双腓骨移植治疗,增强了骨的稳定性,但膝关节融合,丧失了关节功能.     

带血管蒂股骨外侧髁骨膜(骨)瓣移位术的应用解剖

目的　为修复股骨中、下段提供一新的骨膜（ 骨）供区。方法　在４０ 侧成人下肢标本上,解剖观测股骨外侧髁和股骨下段前面的血管来源、走行、分支和吻合情况。结果　膝外上动脉起自月国动脉,经外侧髁上方穿股二头肌腱与股外侧肌间隔至骨面发骨膜支分布于外侧髁的外侧面并参与股骨前面骨膜血管网。股动脉直接骨膜支约在股骨中下１／３ 交界处,发自股动脉,斜向外下行分布于股骨下段前面。结论　以膝外上动脉为蒂的股骨外髁骨膜（ 骨） 瓣移位可修复股骨髁上部;以股动脉直接骨膜支为蒂可修复股骨中段。     

Anatomic study of the nutrient foramen in the shaft of the fibula

The location of the nutrient foramen is important if a free vascularized fibular graft is to include endosteal as well as periosteal blood supply. More than 300 human fibulae were examined to determine the number, location, and size of the foramina in the shaft. Six percent of the bones had no apparent foramen. Ninety-six percent of the foramina were in the middle third of the fibula. In Caucasians this segment of the shaft should be used for free vascularized fibular transfers to increase the likelihood of including the endosteal blood supply.     

Cortical bone remodeling in normal rat

Summary Cortical bone remodeling along the femur diaphysis was determined in normal female rats (Sprague-Dawley) with the tetracycline technique.Three segments on the cortical bone circumference (the anterolateral, the medial, and the posterior) were found to be most suitable for the study of the remodeling process. Oxytetracycline was administered at age 60 and 75 days, and groups of animals were killed at age 75, 85, 95, and 105 days.The accumulated endosteal growth during age 60 to 75 days in the anterolateral segment was found to increase uniformly in the distal direction along the femur diaphysis. A method is described where this accumulated endosteal growth is used. This method eliminates the use of calipers to determine the section level and makes it possible to study comparable sections even after varying periods of time.The proximal part of the diaphysis showed periosteal apposition in all three segments. The periosteal apposition turned into resorption in the distal part of the diaphysis in the anterolateral and medial segments, whereas the periosteal appsition increased in the posterior segment.The endosteal growth increased in the distal direction in the anterolateral and medial segments. Irregular OTC bands made measurements of endosteal remodeling in the posterior segment impossible.The cortical width decreased in the distal direction along the femoral shaft. Comparison between the different age groups is described and also the relation between the accumulated endosteal growth and the diameter of the medullary cavity.     

Bone vascularization and bone healing in the amputation stump. An experimental study.

The osseous healing process of the amputation stump was investigated in adult rabbits. Histological investigation showed that the medullary cavity was closed after 2-3 weeks, chiefly by endosteal callus. After closure of the cavity there was a gradual spongious change in the bone tip and simultaneously the cortex atrophied and the medullary cavity dilated. After amputation on the crus bone rebuilding dominated, whereas after amputation on the femur deterioration of bone was most noticeable. A combination of amputation and medullary plugging caused a change in the course of healing. The medullary cavity did not close until 7-10 weeks after operation and there was distinct periosteal callus formation. The microangiographic investigation showed a transient hypervascularization in the cortex 3-4 weeks after amputation; whereas after simultaneous plugging of the medullary cavity the hypervascularization continued for up to 7 weeks after operation. Following amputation proximally on the crus the arterial supply of the cortex came mainly from the periost, whereas the cortex after distal amputation was vascularized from the medullary cavity. This finding can be due to an interruption of the arterial supply from the nutrient artery associated with proximal amputation, whereas this artery remains intact with amputation distally on the crus.     

Ipsilateral vascularised fibular transport for massive defects of the tibia

The ipsilateral and contralateral fibulae have been used as a vascularised bone graft for loss of tibial bone usually by methods which have involved specialised microvascular techniques to preserve or re-establish the blood supply. We have developed a method of tibialisation of the fibula using the Ilizarov fixator system, ipsilateral vascularised fibular transport (IVFT), and have used it in five patients with massive loss of tibial bone after treatment of an open fracture, infected nonunion or chronic osteomyelitis. All had successful transport, proximal and distal union, and hypertrophy of the graft without fracture. One developed a squamous-cell carcinoma which ultimately required amputation of the limb. The advantage of IVFT is that the fibular segment retains its vascularity without the need for microvascular dissection or anastomoses. Superiosteal formation of new bone occurs if the tibial periosteal bed is retained. Other procedures such as corticotomy and lengthening can be carried out concurrently.     

肩胛骨肋骨及背阔肌肌皮瓣复合组织移植修复胫骨长段缺损一例

目的设计以肩胛下血管为蒂的游离肩胛骨外侧缘、肋骨及背阔肌肌皮瓣复合组织移植修复胫骨长段缺损1例,评价其疗效。方法患者,男,39岁。因外伤致胫骨开放性骨折,在外院行清创植皮和外固定支架固定术后5个月,左胫骨中段骨缺损长达12cm,伴胫骨中上段内侧贴骨瘢痕12cm×6cm。设计并切取肩胛下动脉-胸背动脉为蒂的背阔肌肌皮瓣14cm×5cm、胸背动脉肩胛骨支为蒂的肩胛骨外侧缘骨瓣12.5cm、胸背动脉前锯肌支为蒂的前锯肌-第6肋肋骨瓣13cm。将肩胛下动脉和胫后动脉近端吻合,旋肩胛动脉和胫后动脉远端吻合,肩胛下静脉和小隐静脉吻合;肩胛骨外侧缘骨瓣和肋骨瓣修复胫骨缺损,钢板内固定,背阔肌肌皮瓣覆盖原瘢痕创面。结果复合瓣成活,切口期愈合。术后6个月胫骨植骨上下端骨愈合,经2年随访,患肢已部分负重,术后供区肩关节功能无影响。结论肩胛骨肋骨及背阔肌肌皮瓣复合组织移植是修复胫骨长段骨缺损的一种可选择的有效方法。