上海第六人民医院幻灯模板.ppt

freevascularized bulargraftingcombinedwithalockingplateformassivebonedefectsinthelowerlimbs you shuigao chang qingzhangdepartmentoforthopedicsurgery shanghaisixthpeople shospital shanghai china background massivefemoralandtibialdefectsduetoseveretrauma osteomyelitisandresectionofmalignanciespresentchallengingproblemsfororthopedicsurgeons asanalternative distractionosteogenesisusingtheilizarovtechniquehasprovedofgreatsignificanceinmanipulationofmassivebonedefects however complicationsfollowingthesophisticatedtechniquearenotnegligible treatmentdurationislong andmuchinconvenienceiscausedbythecomplexexternalfixators freevascularizedfibulargrafting fvfg couldbeagoodoptionfortherestorationofmassivebonedefectsinlowerlimbs however post opcomplicationscouldbereach54 followingfvfg andgraftfractureissignificantwithtraditionalstabilization then howtopromotethefunctionalityoftransplantedfibula howtopreventsecondarycomplications araik etal prs2002 alockingplate whichhasbeenwelldescribedinthepublishedliterature achievesadvancesinangularstability integrityofscrewsandplate andelasticstabilization thelockingplatesystemspossessimprovedmechanicalpropertiesandincludenewlydesignedscrewstoanchortheplatesystemfirmlyinthebonewhileexertingcompression dynaminizationofthebone plateconstruct hypertrophyofthetransplantedfibula patientsandmethods eighteenpatientswithamassivebonedefectinalowerlimbreconstructedbyfvfgcombinedwithalockingplatewereretrospectivelyenrolledinthecurrentstudy thedegreeoffibularhypertrophywascalculatedbasedonthemeasurementsfromanteroposteriorimagingatregularintervalsof3months 6months 1 2and3yearspostoperatively repeatedmeasuresanalysisofvariancewasemployedtoevaluateandcomparecorrelativefactorsincludinggender malevs female agedistribution 30years site femurvs tibia andlengthofbonedefect 6 10cmvs 10cm previousnumberofoperations oncevs twice andconcomitantinfection detectedvs non detected therewerefivetime pointsoverthepostoperativefollow upperiod atthreeandsixmonthsandone two andthreeyears results multivariateandstatisticalresults fh 55 fh 85 fh 116 discussion thefibulaundergoesmechanical geometricpriorityandminormorbidityatthedonorsite moreover vesselsaccompanyingthefibulaarerelativelyinvariable factorswhichcombinetomakethefibulaafavoritedonorautograftformassivebonedefectsinreconstructivesurgery fvfgcouldbeausefuloptioninthesalvagingproceduretoreconstructlimbswithmassivedefectsasonetoolinapowerfularmamentarium severalauthorshavereportedtheirexperienceinthemanagementofmassivebonedefectswithipsilateraltranspositionofthefibula itf whichisalsocalledthehuntingtonprocedure weretainedtheipsilateralfibulainsituforitsmechanicalsupport whichwasbetterforearlierweight bearingexercisewhichactsasabiomechanicalstimulusforfibularhypertrophy moreover anintactfibulacouldactasamarkertodiscriminateanydiscrepancyandmaintainaccuratealignmentoftheaffectedtibia deboernoticedthatgrafthypertrophywasmorecommoninthemechanically loadedlowerextremityincomparisonwithupperextremities andhypertrophywasenhancedsignificantlyinpatientsinwhomthegraftwasnotbypassedbyinternalfixation whichcouldinducestressshielding el gammaletal investigatedtheeffectofseveralfactorsonthedegreeofhypertrophy andfoundnosignificantdifferencesbetweenpatientswithregardtoage graftlength reconstructionsite fixationmethod interlockingnailsvs bridgeplatesvs externalfixators orchemotherapyadministration deboerhh etal jbjsbr1989 71 374 378 el gammalta etal microsurgery2002 22 367 370 recentexperimentalandclinicalstudieshavedemonstratedthesuperiorityoflockingplatesinthecareoftibialfractures andthebiomechanicalconditionsprovidedbysuchstabilizationequipmentprobablyactasanimportantinfluencer internalfixators whichareamorelogicalanddiplomaticchoiceforosteosynthesisduetotheirbiomechanicalsuperiority arebetterforfibulartibialization mossdp etal bullnyuhospjointdis2007 65 294 299 pearls athoroughdebridementoftheinfecteddefectwascriticalforpreventionofinfectionrecurrence andvitalreplacementbyfvfgwasanotherimportantfactorforfinaleliminationofthelesionandreconstructionofamassivedefect therationalehastobefollowedwhenalockingplatesystemisused thetransplantedfibulaislivefollowingvascularanastomosis awell designedplanoffunctionalexerciseiscriticallyimportant conclusion freevascularizedfibulargraftingcouldbeagoodchoiceforthereconstructionofmassivebonedefectswhencombinedwithalockingplate factorsincludinggender agedistribution siteandlengthofbonedefects numberofpreviousoperations andinfectiondonotimpacttheprogressoffibularhypertrophy whichimpliesthatintrinsicfactorsmightplayanimportantroleinrestoration wefoundthatthevariablesdiscussedinthecurrentstudydidnotaffecttheprogressoffibularhypertrophy whichimpliesthatintrinsicfactorsmightcontributetotheresultsofhypertrophy althoughthoseconcerningthedegreeofhypertrophywerenon significan