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目的探讨腓骨在骨肿瘤切除后骨缺损重建中的应用。方法回顾本中心2010年至2015年,57例采用游离腓骨移植治疗骨肿瘤患者,其中男22例,女35例,年龄3~62岁。其中骨肉瘤24例,骨巨细胞瘤14例,恶性肿瘤骨转移4例,尤文肉瘤3例,骨纤维结构不良3例,软骨肉瘤3例,动脉瘤样骨囊肿3例,骨囊肿1例,恶性纤维组织细胞瘤1例,毛细血管瘤1例。37例应用带血管蒂游离腓骨移植,20例应用不带血管蒂腓骨移植。术后随访4个月至5年。带蒂腓骨移植37例,移植腓骨长度为5~22 cm,平均14.24 cm;手术时间为2.5~8 h,平均320 min;出血量为100~2300 ml,平均483.78 ml。不带蒂腓骨移植20例,移植腓骨长度为4~15 cm,平均8.78 cm;手术时间为80 min~7 h,平均180 min;术中出血为100~1500 ml,平均340 ml。结果带蒂腓骨移植的病例术后随访7个月至5年,平均29.5个月。6例术后移植骨处骨不连,3例术后肿瘤复发,1例死亡,其余27例移植骨愈合良好且肿瘤无复发。不带蒂腓骨移植的病例术后随访8个月至5年,平均随访30个月。3例术后移植骨处骨不连,1例术后肿瘤复发,2例死亡,其余14例移植骨愈合良好且肿瘤无复发。结论 (1)游离腓骨移植是长骨缺损重建的可靠技术;(2)应根据腓骨移植长度合理的选择是否使用带蒂腓骨移植,建议对骨缺损>7 cm者,选择带蒂腓骨移植;(3)腓骨移植长度、腓骨肌袖、受区血供、吻合血管技术直接影响愈后;(4)成人股骨、胫骨缺损,采用与腓骨复合移植为佳;(5)踝关节不稳应行下胫腓关节融合术;(6)因腓骨生长时间长,须与患者有良好沟通。
Objective To investigate the application of fibula in the reconstruction of bone defects after bone tumor resection. Methods From 2010 to 2015, 57 cases of patients with bone tumor treated by free fibula transplantation were treated in this center, including 22 males and 35 females, aged 3 to 62 years old. Including 24 cases of osteosarcoma, 14 cases of giant cell tumor of bone, 4 cases of malignant bone metastases, 3 cases of Ewing’s sarcoma, 3 cases of fibrous dysplasia, 3 cases of chondrosarcoma, 3 cases of aneurysmal bone cyst, 1 case of bone cyst, 1 case of malignant fibrous histiocytoma, 1 case of capillary hemangioma. Thirty-seven cases were treated with vascularized free fibula graft and 20 cases with non-vascularized fibula graft. The patients were followed up for 4 months to 5 years. Fibular fibular transplantation in 37 cases, the length of the graft fibula 5 to 22 cm, an average of 14.24 cm; operation time was 2.5 to 8 h, an average of 320 min; bleeding volume of 100 to 2300 ml, an average of 483.78 ml. Twenty fibulaless pedicles were transplanted. The length of the peroneal fibula was 4-15 cm (average 8.78 cm). The operative time ranged from 80 min to 7 h (mean 180 min). The intraoperative bleeding ranged from 100 to 1500 ml with an average of 340 ml. Results The cases of pedicle fibula transplantation were followed up for 7 months to 5 years with an average of 29.5 months. 6 cases of postoperative graft bone nonunion, 3 cases of tumor recurrence, 1 case died, and the remaining 27 cases of bone graft healing and tumor recurrence. The cases without pedicled fibula were followed up for 8 months to 5 years with a mean follow-up of 30 months. Three cases of postoperative graft bone nonunion, one case of tumor recurrence, two died, and the remaining 14 cases of bone graft healing and tumor recurrence. Conclusions (1) Free fibula transplantation is a reliable technique for reconstructing long bone defects. (2) Fibular graft should be selected according to the length of fibula graft. ) Fibular bone graft length, fibular muscle sleeve, by the district blood supply, anastomosis vascular techniques directly affect the prognosis; (4) adult femoral and tibial defects, and fibular bone graft better; (5) ankle instability should be under the shin Fibular arthrodesis; (6) due to fibular growth for a long time, patients must have good communication.