肱骨远端难治性骨不连的修复

目的 探索肱骨远端难治性骨缺损与骨不连的显微外科修复方法。方法 肱骨远端骨缺损与骨不连12例，均有外科手术史及植骨史，病程8个月～3年10个月，平均12．5个月。肢体短缩4～11cm，其中8例假关节形成，4例缺损3～5cm。采用解剖钢板固定为支架，取吻合血管的腓骨移植修复，移植腓骨长5～15cm，平均8．5cm。结果 术后12例均获随访3～18个月，平均8．5个月。移植腓骨3～8个月全部愈合，随愈合时间延长，移植腓骨增粗，髓腔再通。退行变的肘关节面骨质恢复正常，肘关节伸屈、前臂旋转功能获得恢复，肢体短缩获得纠正，持重及精细操作均达到满意效果。结论 钢板内固定加吻合血管腓骨移植用于邻近关节疑难骨缺损、骨不连的修复，可重建关节功能，免除关节假体置换。

REPAIR OF REFRACTORY BONE NONUNION IN THE DISTAL HUMERUS

Objective To investigate the effect of microsurgical repair of refractory bone defects and nonunion in distal humers. Methods Twelve cases of bone defects and nonunion indistal humerus were repaired with free vascularised fibular graft and fixed with the anatomical bone plate. Of the 12 cases, 8 had pseudarthrosis, and 4 had bone defects 3 5 cm. Fibular graft ranged from 5 15 cm, 8.5 cm in average. Results After a follow up of 3 18 months, 8.5 months in average, all cases of free vascularised fibular graft healed within 3 8 months. The fibular graft thickened as time passed. Normal recessive osseous elbow joint, improvement in the inflection and extension of elbow joint, and normal revolving of antebrachium were attained. The short of limbs were corrected. Satisfactory functions of supporting and fine operation were attained. Conclusion With the support of anatomical bone plate, the fibular graft can help the recovery of joint function and repair bone defects and nonunion as to avoid joint replacement with prosthesis.