目的探讨带血管腓骨瓣移植修复骨病导致的儿童股骨颈缺损的手术技术及临床疗效。方法选自2018年1月1日~11月30日,因骨病导致的股骨颈缺损或骨不连的6例患者,男2例、女4例;年龄3~12岁,平均8.2岁。初次手术采用病灶刮除植骨内固定术(6例),5例在初次手术失败行二次手术,采用带血管腓骨瓣移植修复重建。术后2年内每3个月随访1次,2年后每6个月随访1次,随访时拍骨盆正位及髋关节侧位X线片,观察肿瘤有无复发、植骨愈合、肢体畸形及短缩及髋关节功能情况。结果 6例术后随访16~48个月,平均26.5个月,随访期间6例病变均未复发。初次手术后4~8个月内2例形成骨不连,3例再次形成髋内翻畸形,骨不愈合,但股骨头均未发生坏死。1例行异体骨块移植重建的患者术后3个月植骨形成愈合,无须二次手术。二次行腓骨瓣移植重建手术后3~6个月,平均4.3个月,移植腓骨瓣桥接股骨头与大粗隆,形成牢固愈合。颈干角矫正平均约18°,患肢短缩纠正平均约2 cm,Harris Hip评分改善平均约30分。结论带血管腓骨瓣移植修复骨病导致的儿童股骨颈缺损的临床疗效满意,但手术难度较大,需临床经验丰富的医生完成。
Objective To explore the surgical technique and clinical efficacy of vascularized fibular bone graft for femoral neck defects in children with bone diseases.Methods From January to December,2018,6 patients(2 males and 4 females;aged 3-12 years,mean 8.2 years)with femoral neck defects or nonunion due to bone disease were selected.The initial operation was performed with curettage,bone grafting and internal fixation(6 cases).Five patients underwent a second operation because of the first operation failure,and the reconstruction with vascularized fibular bone flap was performed.All patients were followed up every 3 months after operation,and every 6 months after 2 years.At the follow-up,the pelvic AP and hip lateral radiographs were taken to observe the tumor recurrence,healing of the bone graft,limb malformation and shortening and hip function.Results Six patients were followed up for 16 to 48 months,with an average of 26.5 months.During the follow-up period,6 patients had no recurrence.Two patients developed nonunion within 4 to 8 months after the initial operation,and 3 patients developed hip varus deformity again.The bone did not heal,but no necrosis occurred in the femoral head.One patient who underwent allogeneic bone graft reconstruction healed 3 months after surgery,without secondary surgery.The second fibular bone graft was reconstructed 3 to 6 months after surgery,with an average of 4.3 months.The grafted fibula bone flap bridged the femoral head and large trochanter,forming a firm healing.Collodiaphyseal angle correction averaged about 18 degrees.The affected limb shortening was corrected about 2 cm on average.Harris Hip score improved by an average of about 30 points.Conclusions Clinical outcomes of vascularized fibular bone graft for femoral neck defects in children with bone disease is satisfactory,but the operation is difficult and requires a doctor with rich clinical experience.
Chinse Journal Of Bone Tumor And Bone Disease
Femoral neck defect
Fibular bone flap