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| 題 名 | 以雙段式腓骨中隔骨皮瓣重建間段性股骨缺損 |
|---|---|
| 作 者 | 張宇正; 林志鴻; 魏福全; | 書刊名 | 中華民國重建整形外科醫學會雜誌 |
| 卷 期 | 4:4 1995.12[民84.12] |
| 頁 次 | 頁276-281 |
| 分類號 | 416.413 |
| 關鍵詞 | 帶血管莖之骨移植; 腓骨中隔骨皮瓣; 雙段式; Vascularized bone graft; Free vascularized fibular osteoseptocutaneous flap; Double struts; |
| 語 文 | 中文(Chinese) |
| 中文摘要 | 肢體骨骼缺損之重建若以帶血管莖之骨移植(vascularized bone graft),由於其骨細胞在移植後能繼績存活,其癒合機轉類似單純骨折,因此一般適合重建骨缺損大於6∼8公分以上,傷口附近血液循環不佳或有感染的情況。從1984年8月至1993年9月共有17位病患接受以腓骨中隔骨皮辦(vascularized fibular osteoseptocutaneous flaps)重建間段性股骨缺損(segmental femoral defect)且追蹤檢查至少一年半以上。所有患者皆因摩托車車禍引起,其股骨缺損介於6∼18公分之間。其中2例骨缺損是原發生於車禍,其餘15例骨缺損則是因二次感染及骨擴創術(sequestrectomy)所致。 腓骨移植方式有7例為雙段性腓骨(double struts),其餘10例為單段腓骨(single strut)。原發性骨瘡合(primary bone union)有13例(76.4%),3例因骨延遲癒合(delayed bone union)及1例因骨釘鬆動移位(23.6%),再追加傳統性骨移植及固定之步驟。平均X光上之骨癒合期為八個月,可以全部承重(fu11 weight bearing)為17個月。所有病例無一有再發性感染情況。4例於成功腓骨中隔骨皮瓣移植後再進行四頭肌成形術(quadriceps plasty)或關節鬆弛術(arthrolysis)以改善膝關節活動度,最後滕關節活動度則介淤0至80度之間。比較雙段式與單段式腓骨移植發現前者無一有骨延遲癒合或移植後骨折,其物理支撐(mechanical support)及變肥厚後(hypertrophy)的程度亦較好,因此可能可以提早承受重量及不使用支架(brace),因此我們認為以雙段式腓骨中隔骨皮辦應為重建間段性股骨缺損之優先選擇。 |
| 英文摘要 | 17 reconstructions of the segmental femoral defect using vascularized fibular osteoseptocutaneous flaps were performed from August, 1984 to September, 1993. All had a follow-up period of at least one and half years. All cases had sustained high energy trauma in motor vehicle accidents, and resulting in a bone defect, ranging from 6 to 18 cm in lenght. The skeletal defect was primary in 2 cases due to bone loss at the time of accident and secondary in 15 cases following infection and sequestrectomy. The fibular graft was inserted as a double struts in 7 cases and as a single strut in 10 cases. Primary bone union was achieved in 13 cases (76.4%). Supplemental bone grafting and internal fixation were required in 4 cases (23.6%) due to delayed bone union and loosening of the screw. Overall, the average time to radiological union was 8 months and full weight bearing was 17 months. At final evaluation, no case showed evidence of persistent infection. Four cases required quadriceps plasty and arthrolysis. The average arc of active knee motion was from zero to 80 degree. Comparing double struts with single strut fibular graft, the former showed no case of delayed bone union or refracture. Our experience indicates that the double struts vascularized osteo-septocutaneous fibular transfer should he considered as an ideal option for reconstruction of segmental femoral defect. |
本系統中英文摘要資訊取自各篇刊載內容。