吻合血管的腓骨移植治疗先天性胫骨假关节

目的 探讨应用游离腓骨移植一次修复,或结合骨延长技术二次修复治疗先天性胫骨假关节的可行性与有效性.方法 收治先天性胫骨假关节病例16例,男9例,女7例;年龄6～14岁,平均8.5岁;均有骨移植或骨延长手术史.手术次数2～6次,平均3.2次;下肢短缩3～12 cm,平均5.8cm.16例均采用游离腓骨移植的方法修复,腓骨切取长度6.0～16.0 cm,平均9.2 cm.1年后其中4例采用骨延长的方法进行肢体延长. 结果 14例均得到随访,随访时间2～8年,平均4.5年,移植的腓骨均成活、变粗,4例下肢延长长度4.0～11.5 cm,平均7.8 cm,均恢复基本的行走功能. 结论 采用病灶彻底切除长段游离腓骨移植是治疗顽固性胫骨假关节的有效方法.配合二期骨延长可以改善肢体长度的不足.

Treatment of adversity congenital pseudarthrosis of the tibia by anastomosis vascular fibular transplantation

Objective To explore the feasibility and effects of one stage vascular free fibular transplantation or combination of bone transport two-stage technique for reconstruction of adversity congenital pseudarthrosis of the tibia. Methods Vascularised free fibular reconstruction operations for adversity congenital pseudarthrosis of tibia were performed in 16 cases, including male in 9 and female in 7,age ranged from 6 to 14 years with the mean in 8.5 years. 2 to 6 operations history were documented in all cases with the mean in 3.2 before went to our hospital, with 3 to 12 cm and mean 5.8 em short of the tibia. Mean9.2 cm (from 6.0 to 16.0 cm) vascular free fibular were harvested and transplanted to reconstruct the bone frame in 16 cases, bone transport operation were performed in 4 cases 1 year later. Results Fourteen cases were followed up for mean 4.5 years, bone union could be found by radiology examination, mean 7.8cm (from 4.0 to 11.5 cm) elongation of the low limb were obtained in 4 cases. Basic walking function was obtained in all cases. Conclusion It is an effective method to treat adversity congenital psuedarthrosis of the tibia by thoroughly resection of the focus and enough length of vascular fibular transplantation, deficiency of low limb can be ameliorated by bone transportation technique in those patients.