摘要目的 为带血管蒂腓骨头骨骺截骨整形重建内踝提供解剖学依据,并探讨其临床应用效果.方法 20侧2～12岁新鲜儿童下肢标本,对腓骨头及内踝进行形态学测量,根据测量数据推导截骨公式.临床急诊或延期手术,移植截骨改良的腓骨头骨骺复合组织瓣一期修复内踝缺损,随访观察临床效果.结果 腓骨头倾斜角(M)为(170±8)°,关节面内倾角(N)为(145±6)°,纵长为(1.5±0.2)cm,横宽为(1.4±0.2)cm;内踝内翻角(L)为(152±8)°,关节面纵长为(1.25±0.2)cm,横宽为(1.25±0.2)cm.设内踝缺损面与胫骨纵轴的夹角为(Q),截骨角度X=L-N-Q,顶点位于腓骨头倒置后的关节面上1/6处.临床应用6例,全部一期愈合,随访1～3年,内踝发育良好,未发生骺早闭,无内翻畸形,踝关节负重、行走功能正常.结论 儿童腓骨头骨骺与内踝形态有一定的差异,通过截骨可获得满意的供体,同时携带皮瓣可一期修复内踝骨骺及周围软组织缺损并同步发育,是重建儿童内踝创伤性缺损的理想方法.

abstractsObjective To provide an anatomical basis for repairing the medial malleolus with bone-severed vascularized fibular head epiphysis, and to explore the effect of clinical application with this method. Methods Figures of fibular head and medial malleolus were measured on 20 fresh lower limbs specimens of child age from 2 to 12 years old, then bone-severed formula was deduced. The bone-severed composite fibular head epiphysis to repair the defect of medial malleolus were carried for 6 child patients of emergency or post-poned cases on one stage. Obersved the clinical effect by following-up. Results The angle between fibular head and stem (M) was(170±8)°, angle of fibular head sadacc(N) was (145 ±6)°, length(1.5±0.2)cm and width (1.4±0.2)cm; angle between medial malleolus and stem(1) was(152±8)°, length of the articular surface of medial malholus was(1.25 ± 0.2)cm and width (1.25 ± 0.2)cm. Angle between defect surface and tibia was(Q). Formula: angle of bone-severing X = L-N-Q, and apex at the upper 1/6 of the reversed articular surface of fibular. 6 cases with this method was completed, all healed at stage one, following-up 1 to 3 years, medial malleolos developed well and no epiphysis ossification anticipation, and the ankle joint has no inversion with its loadind and walking function good. Conclusion The fibular head epiphysis and the medial malleolus differ in shape to some extent, but good donor can be got by bone-severing, can repair the epiphysis and soft tissue defect of the medial malleolus at one stage with additional flap, developing with the child at the same time, it is a perfect method to reconstruct the traumatic defect of child medial malleohs.