摘要目的 探讨游离腓骨骨皮瓣移植结合载抗生素硫酸钙人工骨植骨一期治疗前臂Cierny-Mader IV型慢性骨髓炎的疗效及其应用价值.方法 回顾性分析2013年8月至2017年5月应用游离腓骨骨皮瓣移植结合载抗生素硫酸钙人工骨植骨一期治疗的尺骨或(和)桡骨Cierny-Mader IV 型慢性骨髓炎12 例资料,男7例,女5例;年龄36.3(21~47)岁;单纯尺骨骨髓炎7例,桡骨骨髓炎4例,尺、桡骨双骨骨髓炎1例;骨髓炎病灶范围平均6.3(3.0~9.0) cm,软组织缺损(包括贴骨瘢痕)面积 8.0 cm×2.0 cm~15.0 cm×5.0 cm.皮瓣面积10.0 cm×3.5 cm ~17.0 cm×7.0 cm;腓骨瓣长度平均8.8(5.0~12.0) cm;单纯锁定钢板内固定9例,外固定架固定2 例, 钢板结合外固定架固定 1 例.植入硫酸钙人工骨有效成分万古霉素/庆大霉素平均 0.64 g/10.27万U (0.4 g/6.4万U~1.0 g/16.0万U).术后前半年每个月门诊复查, 半年后每3个月门诊复查.术后1年分别应用Mayo肘关节功能指数、Anderson前臂双骨折评价系统及Cooney腕关节功能评分对肘、前臂及腕关节功能综合评估.结果 术后发生血管危象1例,及时手术探查,最终12例皮瓣均完全成活.所有供瓣区愈合良好.供区侧下肢功能较术前无改变.经平均22.7(15~34)个月随访:2例出现尺神经支配区感觉障碍,术后3个月恢复正常;腓骨瓣均获得满意骨性愈合,愈合时间平均4.7(3~6)个月;术后第3个月复查X线片均未再见到硫酸钙人工骨颗粒影;术后12个月对肘、腕关节及前臂功能进行综合评估:Mayo肘关节功能指数:可4例,差8例;An-derson前臂双骨折评价系统:良4例,可8例;Cooney腕关节功能评分:优7例,良2例,可2例,差1例.骨性愈合、前臂外观及腕关节功能康复良好,但肘关节及前臂运动功能恢复不满意.结论 在熟练掌握显微外科应用解剖及血管吻合技术的基础上,游离腓骨骨皮瓣移植结合载抗生素硫酸钙人工骨植骨一期治疗前臂 Cierny-Mader IV型慢性骨髓炎取得满意疗效,受区美观,骨性愈合可靠,对受区及供区功能影响小,值得临床推广应用.

abstractsTo investigate the effect and application value of transplantation of the free cutaneous fibular flap combined with antibiotic-loaded calcium sulfate artificial bone graft for the treatment of antibrachial chronic osteomyelitis of Cierny-Mader type IV. Methods From August, 2013 to May, 2017, 12 cases of ulna or (and) radius chronic osteomyelitis of Cierny-Mader type IV were treated by transplantation of the free cutaneous fibu-lar flap combined with antibiotic-loaded calcium sulfate artificial bone graft. There were 7 males and 5 females, with an average age of 36.3 (21-47) years.Pure ulnar osteomyelitis in 7 cases, radius osteomyelitis in 4 cases, and both ul-nar and radius osteomyelitis in 1 case. The average range of osteomyelitis lesions was 6.3 (3.0-9.0) cm. The area of soft tissue defect (including bone scar) ranged from 8.0 cm×2.0 cm to 15.0 cm×5.0 cm. The area of the flap was 10.0 cm×3.5cm-17.0 cm×7.0 cm.The average length of the fibular flap was 8.8 (5.0-12.0) cm.Locking plate internal fixa-tion was used in 9 cases, external fixator in 2 cases, and plate combined with external fixator in 1 case. Vancomycin/gentamicin, an effective component of calcium sulfate artificial bone, averaged 0.64 g/102.7 kU (0.4 g/64 kU-1.0 g/160 kU).Routine postoperative treatment.And monthly outpatient review in the first half year after operation, and outpatient review every 3 months after half a year.One year after operation, comprehensive evaluation of elbow, forearm and wrist function with Mayo Elbow Function Index, Anderson Forearm Double Fracture Evaluation System and Cooney Wrist Function Score. Results Vascular crisis occurred in 1 case after operation, prompt surgical exploration, and ultimately all flaps survived completely.The donor sites healed well in all cases.The lower extremity functions of donor sites had no change compared with that before operation.Followed-up of an average of 22.7 months, there were 2 cases who had sen-sory disturbance in the ulnar nerve innervation area and returned to normal 3 months after operation. The fibular flaps healed satisfactorily with an average healing time of 4.7 (3-6) months.No calcium sulphate artificial bone granules were seen on X-ray at 3 months after operation.One year after operation, bone healing, forearm appearance and wrist function recovered well, but elbow and forearm motor function recovered unsatisfactorily. Conclusion On the basis of master-ing the applied anatomy and vascular anastomosis techniques of microsurgery, this method of transplantation of the free cutaneous fibular flap combined with antibiotic-loaded calcium sulfate artificial bone graft for the treatment of an-tibrachial chronic osteomyelitis of Cierny-Mader type IV has achieved satisfactory results.The recipient area is beautiful. The bone healing is reliable.And it has little influence on the recipient area and the donor area.It is worthy of clinical application.