久治不愈儿童期肢体骨折术后感染所致长段骨缺损的重建治疗

目的探讨儿童期骨折术后感染致长段骨缺损、骨骺损害的成因及其预防和修复手段.方法对2例儿童期肢体骨折（胫腓骨、肱骨各1例）术后感染性骨缺损,经过1年和10年反复治疗失败形成的骨感染、骨缺损、骨外露和肢体短缩、假关节畸形肢体,进行一次性病灶清除、骨畸形矫正,并以游离腓骨皮瓣移植完成一次性骨结构重建修复创面.结果移植骨皮瓣一次性成活,伤肢于手术后半年达到骨性愈合并恢复持重和行走功能.结论游离腓骨皮瓣移植是治疗儿童期骨折术后感染所致长段骨缺损的理想方法,骨折术后感染早期合理救治对于避免继发骨及骨骺损害有着重要的临床意义.

The treatment of reconstructing long bone defects as a result of longterm postoperative infections following fractures in the childhood

Objective To probe the pathogenesis of long bone defects and damage to epiphysis as the result of postoperative infections following fractures in the childhood of patients, and to look for ideal ways to prevent and repair the defects and damages, Methods The treatment of the infected bone defect of a tibia had been continued for one year following fracture in one four-year old patient, and the treatment of the infected bone defect of a humerus had been continued for ten years following fracture in another seven-year old patient, but all the treatments had failed. The injured limbs developed bone infection, bone defect, bone exposure, shortening, and pseudoarthrosis deformities at last. Then the lesions were completely cleaned, and the deformities of the infected bones were corrected in one stage, with reconstruction of the bone and the repair of the wounds by transplantations of fibular free flaps. Results Both fibular free flaps survived in one stage transplantation. The bones of the injured limbs healed half a year after the operations, and weight-bearing and walking functions of the injured limbs recovered as well. Conclusion Transplantation of fibular free flap was an ideal way to treat a long tone defect as a result of postoperative infection following fracture in the childhood. The early appropriate treatment of postoperative infection following frac- ture is very important to avoid bone and epiphysis damages.