摘要目的 探讨胫骨创伤后节段性骨缺损的治疗方法及其临床效果.方法 1985年至2003年,本院共收治胫骨骨缺损28例.其中自体松质骨移植10例,牵拉骨生长术12例,带血管蒂腓骨移植6例.结果 自体松质骨移植10例,深部感染1例,再发骨折1例;骨不连2例,平均愈合时间为30周,全部病例行2～5年随访.牵拉骨生成技术12例,骨缺损愈合延迟愈合4例,平均愈合时间38周,1例因治疗失败而行截肢术.带血管蒂腓骨移植6例,除1例8 个月骨性愈合外,术后3～6个月均达骨性愈合.供体部位病变1例,再发骨折发生1例,二次手术愈合.结论 自体质骨移植、游离带血管蒂蒂腓骨移植、牵拉骨生成技术等治疗节段性骨缺损疗效比较肯定,但持续时间长,且伴有很高的并发症发生率.

abstractsObjective To explore the methods and clinical effects posttraumatic segmental tibia defects.Methods From 1985 to 2003, the data of 28 cases of segmental tibig defects ware studied retrospectively. 10 cases were treated with autologous cancellous bone graft, 12 cases were done by distraction osteogenesis,and 6 cases were done by free vascularized fibula bone transfer. Results In the 10 cases of autologous cancellous bone graft, 1 case had deep infection, 1 case refractured,and 2 cases were unuioned. The average time of healing was 30 weeks. Among the 12 cases of distraction osteogenesis,4 cases were delayed union, 1 case needed amputation for treatment failure. The mean healing time was 38 weeks. In the 6 cases of free vascularized fibula bone transfer, 1 case had donor site morbidity,and 1 case was refractured who was unioned by second operation. Besides 1 case who was not synostosised until 8 months, the rests were synostosised between 3 and 6 months. Conclusion Although each of the new techniques of autologous cancellous bone graft and distraction osteogenesis and free vascularized fibula bone transfer has shown some limited success, complications remain common, and the time of treatment was too long.