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大段骨缺损的治疗仍是临床存在的难题，对骨缺损＞6cm或合并感染的骨不愈合，特殊手术技术，包括Masquelet技术，骨牵引技术或血管化骨移植显得至关重要。 对胫骨大段骨缺损，有学者采用同侧血管化的腓骨移植，并采用锁定钢板外固定替代传统外固定架，相关结果发表在2021.06 Injury期刊上。
Introduction（介绍） 胫骨大段缺损的处理仍是骨科医师面临的挑战。本研究的目的是确认在某些困难情况下应用同侧带血管腓骨移植结合外锁定钢板治疗大段胫骨缺损的可行性和可靠性。 [Introduction: Management of massive tibial bone defects remains challenging for orthopaedic doctors. This study aimed to ascertain the viability and reliability of utilising an ipsilateral vascularised fibula with an external locking plate for the difficult situation.] Materials and Methods（材料与方法） 自2012年1月至2017年12月间，纳入8例（7例男性）平均年龄32.3岁（19-54）并采用上述技术治疗的胫骨大段缺损患者。平均骨缺损长度12.4cm（8-20cm）。评估患者临床及影像学结果，采用DeBoer-Wood方法及SF-36评分评估腓骨移植后功能。 [Materials and Methods: Between January 2012 and December 2017, eight patients (7 men) with a mean age of 32.3 (19-54) years who presented with massive tibial bone defects were treated using the described technique. The mean length of the bone defect was 12.4 (8-20) cm. The patients were assessed for clinical and radiographic results, hypertrophy of the fibular graft with DeBoer and Wood’s method, and SF-36 functional score.] Results（结果） 平均随访时间40.3（26-60）月。平均愈合时间5.6（3-8）月。末次随访，所有患者均获得移植物愈合，并自由行走。平均移植物肥大系数（graft hypertrophy index）为98.2%，5例患者SF-36评分大于75%，3例患者评分在50-75%。3名患者的两腿差异大于1.5cm。2例马蹄足患者采用胫骨融合术进行治疗。3名患者患有针道感染。在2例患者中有四个螺钉被折断。 [Results: The mean follow-up period was 40.3 (26-60) months. The average time for union was 5.6 (3-8) months. At the final follow-up, all patients had fully united grafts and walked without restriction. The mean graft hypertrophy index was 98.2 %. The SF-36 score was > 75 % in five patients, and 50-75 % in three. Three patients had a leg length discrepancy of > 1.5 cm. Two patients with equinus foot were treated using tibiotalocalcaneal fusion. Three patients had pin-tract infections. Four screws were broken in two cases.]
图1：（A1、A2）21岁男性，清创后出现节段性骨缺损(20 cm)。在胫骨达到适当的对齐后，外部锁定板被用作最终的固定器。（B1、B2）胫骨术后即刻正位和侧位片。(C1、C2)术后12个月的前后和侧位片显示骨愈合伴移植骨肥大。踝关节马蹄畸形，行胫骨融合术。(D1)场景图显示右侧肢体缩短3 cm。(D2)最终随访时患者的临床照片
图2：(A1、A2)一名41岁的开放性胫骨骨折患者在左胫骨出现严重感染的创伤后骨不连，导致节段性骨缺损。他接受了多次清创手术和失败的同侧非血管化腓骨移植。(B1)术中照片显示外锁定板固定左胫骨，并收获12厘米同侧血管腓骨移植。(B2)将腓骨转移到胫骨缺损处，用螺钉固定两端。(C1、C2)左胫骨术后即刻的正位和侧位片。(D1、D2)术后12个月的前后和侧位片显示愈合和肥大。 Conclusion（结论） 同侧血管化腓骨移植联合外锁定钢板作为最终的外固定器提供了一种简单舒适的治疗方法，以及合适的机械负荷和移植部位的血管化，以实现腓骨移植物的肥大。因此，我们的技术可作为治疗巨大胫骨骨缺损的一个有价值的选择。 [Conclusion: Ipsilateral vascularised fibular transfer combined with an external locking plate as a definitive external fixator provides a simple and comfortable treatment, and appropriate mechanical loading and vascularisation of the graft site to achieve hypertrophy of the fibular graft. Hence, our technique can serve as a valuable alternative for the treatment of massive tibial bone defects.]  |
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