摘要目的:初步探讨和比较吻合血管的游离腓骨瓣移植术和Ilizarov骨搬运术治疗肱骨骨折内固定术后感染性骨缺损的疗效。方法:回顾性分析新疆医科大学第一附属医院骨科中心显微修复外科于2017年1月至2023年1月,采用游离腓骨瓣移植或Ilizarov骨搬运治疗的29例肱骨骨折内固定术后感染性骨不连患者的临床资料。游离腓骨瓣移植术组12例,肱骨骨缺损长度为4.0~6.0 cm,平均5.1 cm。Ilizarov骨搬运术组17例,肱骨骨缺损长度为6.0~10.0 cm,平均7.3 cm。术后对两组患者采取门诊复诊、微信、电话相结合的方式进行规律随访,随访内容包括肱骨X线片和肩、肘关节功能。采用SPSS 27.0进行数据分析,对两组患者的基本资料(年龄、性别、骨缺损长度、骨愈合时间、随访时间等）进行同质性检验。 P<0.05为差异有统计学意义。 结果:本组29例患者均获得随访,随访时间为8~89个月,平均41.3个月。两组结果比较：游离腓骨瓣移植术组和Ilizarov骨搬运术组骨缺损长度分别为（5.2±0.5）cm、（7.0±1.2）cm,骨愈合时间分别为（6.4±1.8）个月、（14.2±4.6）个月,随访时间分别为（17.6 ± 6.8）个月、（34.4 ± 18.2）个月。Constant-Murley肩关节评分分别为（86.0±8.6）分、（82.4±10.0）分,Enneking下肢功能评分：游离腓骨瓣移植术组（25.0±3.4）分,Ilizarov骨搬运术组未做下肢手术故未评价。Ilizarov骨搬运术组骨缺损、骨愈合时间、随访时间与游离腓骨瓣移植术组相比,差异均有统计学意义（ P<0.01）。Constant-Murley肩关节评分两组相比差异无统计学意义（ P>0.05）。游离腓骨瓣移植术组：1例患者术后腓骨供区血肿形成,再次手术清除血肿后术区顺利愈合,1例患者组合外固定架松动导致移植的腓骨骨折,调整臂外固定架,术后8个月骨折愈合,术后10个月拆除外固定；Ilizarov骨搬运术组：3例患者骨断端愈合不佳,2例患者轴向偏移,搬运过程中调整外固定架,予以纠正轴向偏移,1例患者出现桡神经不全损伤,行桡神经探查松解手术,术后3个月出现肌力改善,术后7个月伸腕、伸指功能恢复。其余病例顺利愈合。 结论:在治疗感染性肱骨缺损时,骨移植可能是治疗较大肱骨缺损的更好选择,而游离腓骨瓣转移更适合治疗较小的肱骨缺损。

abstractsObjective:To preliminarily explore and compare the efficacy of free fibular flap transfer with vascular anastomosis and Ilizarov bone transport in treatment of infected bone defects after internal fixation of humeral fractures.Methods:A retrospective analysis was conducted on 29 patients who were treated by transfer of free fibular flap and Ilizarov bone transport for infected nonunion of humeral fractures after internal fixation in the Department of Trauma and Microreconstructive Surgery, the First Affiliated Hospital of Xinjiang Medical University between January 2017 and January 2023. Twelve patients with humeral defects at 4.0 - 6.0 cm in length (5.1 cm in average) were treated with free fibular flap transfer (flap transfer group) and 17 patients with humeral defect at 6.0-10.0 cm in length (7.3 cm in average) were treated by Ilizarov bone transport (bone transport group). All patients were included in the scheduled postoperative follow-up through a combination of outpatient visits and WeChat and telephone interviews. Follow-up included observation of humeral X-ray and shoulder-elbow function. Data were analysed using SPSS 27.0. Homogeneity tests were conducted on the basic data of the 2 groups, such as age, gender, length of bone defect, bone healing time and follow-up period. P<0.05 was considered statistically significant for the difference. Results:All 29 patients had completed the postoperative follow-up that lasted 8-89 months with 41.3 months in average. The lengths of bone defects were 5.2 cm±0.5 cm and 7.0 cm±1.2 cm, the bone healing time was 6.4 months±1.8 months and 14.2 months±4.6 months, and the follow-up time was 17.6 months±6.8 months and 34.4 months ±18.2 months in flap transfer group and bone transport group, respectively. Constant-Murley shoulder score was recorded of 86.0 ± 8.6 and 82.4±10.0 respectively for flap transfer group and bone transport group. Enneking Lower Extremity Functional Score in the flap transfer group was 25.0 ± 3.4, while that for bone transport group was not evaluated due to the absence of lower extremity surgery. There were statistically significant differences in bone defects, bone healing time, and follow-up time between the 2 groups ( P<0.01). There was no statistically significant differences in Constant-Murley shoulder score between the 2 groups ( P>0.05). However, in the flap transfer group, 1 patient developed a haematoma at fibular donor site after surgery, and the haematoma was removed in a secondary surgery, after which the surgical site healed smoothly. The external fixator had gone loose in 1 patient and resulted in a fracture of the transferred fibula. After the external fixator was re-fixed, the fracture healed at 8 months after surgery, and the external fixator was removed at 10 months after surgery. In the bone transport group, 3 patients had poor bone healing at fracture ends. Two patients had axial shifting of bones, the external fixator was adjusted during the bone transport process to correct the bone shifting. One patient suffered an incomplete radial nerve injury, and the radial nerve exploration and release surgery was performed. For that patient, an improvement of muscle strength was seen at 3 months and the wrist and digital extensions regained at 7 months after the radial nerve release surgery. The rest of humeri healed smoothly. Conclusion:In treatment of an infected humeral defect, it was found that a bone transport might be a better option for a larger humeral defect, while the free fibular flap transfer would be more suitable for a smaller humeral defect.