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 .

The repair of long bone defect in fibrous dysplasia of lower extremities with two fibula compound transplantation inside periosteum

Objective To study the methods of repairing bone defects in fibrous dysplasia of lower extremities with two fibula compound transplantation inside periosteum.Methods Six patients with fibrous dysplasia were treated from May 1995 to August 2003.There were 5 males and 1 female with the mean age of 25.5 years (range, 14-40 years).The tumor located at shaft of tibia in 2 patients and shaft of femur in 4 patients.Pathological diagnosis: osteofibrosis dysplasia.The length of the bone defective incomplete was 15 to 22 cm when tumor was ablated.The length of the double fibula for transplant was 17 to 24 cm, which was 2 cm more than the length of the bone defect needing to repair.The anterior-lateral fibular periosteum of the two fibulas were incised vertically, which was stripped to bone ridge.Then folded the two fibula or the two parts of fibula that the anterior-lateral fibula were contacted directly.The opposite sides of periosteum were suture to wrap the double thick fibula, and two end of the fibula were fixed, which was used to repair the bone defects.Results All 6 bone defects were healed.Bone got union after 1 year and cavitas medullaris got recanalization after 5 years.There were not tumor evidences in the transplanting double fibulas, and X-rays confirmed normal ossature.Only 1 patient's tumor relapsed in the distal segment of the normal shaft of femur, but the transplanting double fibular was not involved.The transplant bone accreted well, there was no complication of bone disunion and infection of bone.The articular genu recovered extend -flexion function.The patients could complete daily activities.Conclusion The repair of long and thick bone defects by two fibula compound transplantation inside periosteum is effective.