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題名 | Treatment of Segmental Tibial Loss by Using Tibialization of the Ipsilateral Fibula in Gustilo Type IIIC Open Tibiofibular Fractures--Two Cases Report=以同側帶莖腓骨皮瓣脛骨化作為Gustilo Type IIIC開放性腓骨脛骨骨折併脛骨部分缺失的重建方式 |
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作者 | 王啟宇; 周昌益; 張鈞凱; 吳建儒; 瞿子翔; 陳天牧; 陳錫根; 張舜程; Wang, Chi-yu; Chou, Chang-yi; Chang, Chun-kai; Wu, Chien-ju; Chi, Tzi-hsiang; Chen, Tim-mo; Chen, Shyi-gen; Chang, Shun-cheng; |
期刊 | 臺灣整形外科醫學會雜誌 |
出版日期 | 20160300 |
卷期 | 25:1 2016.03[民105.03] |
頁次 | 頁49-57 |
分類號 | 416.413 |
語文 | eng |
關鍵詞 | 開放性腓骨脛骨骨折; 脛骨缺失; 同側帶莖腓骨皮瓣脛骨化; Tibiofibular fracture; Fibular tibialization; |
中文摘要 | 背景:對病患及外科醫師來說,治療開放性腓骨脛骨骨折併脛骨部分缺失是一個十分棘手的問題。目的及目標:我們選擇以同側帶莖腓骨皮瓣脛骨化作為治療開放性腓骨脛骨骨折併脛骨部分缺失的方式。材料及方法:兩位因車禍創傷機轉及結果類似的病患,皆因創傷造成Gustilo type IIIC同側脛骨腓骨開放性骨折併遠端腓動脈斷裂及脛骨部分缺失。我們以同側帶莖腓骨皮瓣脛骨化將斷裂的腓骨塞入同側脛骨缺失的部分作傷口重建,並於六個月後加作鋼板內固定手術加強患肢的支撐力。結論:以往文獻討論脛骨缺失的重建方式相當多,也都各有其優缺點。經由我們的經驗,發現Gustilo typeIIIC脛骨腓骨骨折的病患,因為其同側的脛骨腓骨及遠端腓動脈皆已斷裂,使用同側帶莖腓骨皮瓣脛骨化有比較高的可利用性。除了不用承擔顯微手術的風險之外,還包括了兩項優點:一、皮瓣旋轉半徑大(遠端腓動脈已斷裂),二、可裁切適合的腓骨大小(腓骨已斷裂)。在不額外造成其他傷害的前提之下,倘若剛好面對的急性開放性骨折病患屬於Gustilotype IIIC脛骨腓骨骨折併遠端腓動脈斷裂,那麼以同側帶莖腓骨皮瓣脛骨化作為Gustilo type IIIC開放性腓骨脛骨骨折併脛骨部分缺失的重建方式,是一個可以考慮的手術。 |
英文摘要 | Background: The treatment of segmental bone loss that has resulted from acute trauma has traditionally been a complex surgical problem. Segmental tibial defects are challenging therapeutic problems for both the physician and the patient. Aim and objectives: We report successful reconstructions, in two patients with segmental tibial loss, by using island pedicled tibialized fibular flaps. Materials and Methods: Two similar patients sustained crush injuries during vehicle accidents that resulted in extensive soft tissue damage and tibiofibular fractures. Both patients suffered from segmental Gustilo type IIIC fractures of the tibia and fibula, with peroneal vessel injuries. The reconstructions were performed using ipsilateral pedicled fibular flaps and the placement of fibular struts impacted into the medullary canal or bridging to the tibial defect by transcortex alignment. Results: Good bone union alignment was found in the follow-up radiographs. After successful synostosis, the patients engaged in activities of daily living with normal weight bearing. Conclusion: The advantage of the ipsilateral pedicled fibular flap is that the fibular segment retains its vascularity, without the need for requiring microvascular dissection or anastomoses. |
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