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首页> 外文期刊>The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons >Vascularized Pedicled Fibula Onlay Bone Graft Augmentation for Complicated Tibiotalocalcaneal Arthrodesis With Retrograde Intramedullary Nail Fixation: A Case Series
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Vascularized Pedicled Fibula Onlay Bone Graft Augmentation for Complicated Tibiotalocalcaneal Arthrodesis With Retrograde Intramedullary Nail Fixation: A Case Series

机译：血管化带蒂腓骨植入骨移植治疗复杂的胫腓骨关节置换术并逆行髓内钉固定术：病例系列

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摘要

Tibiotalocalcaneal arthrodesis stabilized with retrograde intramedullary nail fixation is associated with a high incidence of complications. This is especially true when performed with a bulk structural allograft and poor soft tissue quality. In select high-risk limb salvage cases, we have augmented tibiotalocalcaneal arthrodesis procedures stabilized using retrograde intramedullary nail fixation with a vascularized pedicled fibular onlay bone graft. We present the data from 10 such procedures with a mean follow-up period of 10.9 +/- 5.4 (range 6 to 20) months involving 10 patients (9 males and 1 female). The etiology was avascular osteonecrosis of the talus and/or distal tibia and a resultant large volume cavitary bone defect (8 ankles), severe equinocavovarus contracture (1 ankle), and failed total ankle replacement (1 ankle). A frozen femoral head bulk allograft was used twice, a whole frozen talus allograft once, and a freeze-dried calcaneal allograft once. The fibula was mobilized with intact musculoperiosteal perforating branches of the peroneal artery as a vascularized pedicle onlay bone graft fixated with a screw and washer construct. The mean fibular graft length was 10.2 +/- 2.3 cm. The mean interval to radiographic fusion was 2.6 +/- 0.6 months and to weightbearing was 3.1 +/- 1.4 months. Two stable bulk allograft-host bone and fibular graft-host bone nonunions occurred after intramedullary nail hardware failure. Tibiotalocalcaneal arthrodesis augmented by vascularized pedicled fibular graft stabilized with retrograde compression intramedullary nail fixation offers a reliable option for complex salvage situations when few other options exist. (C) 2016 by the American College of Foot and Ankle Surgeons. All rights reserved.
机译：逆行髓内钉固定稳定的胫bio局部关节固定术与并发症高发相关。当采用同种结构的同种异体移植物和较差的软组织质量进行手术时，尤其如此。在某些高危肢体抢救病例中，我们采用了带血管蒂蒂腓骨植入植骨的逆行髓内钉固定术，从而增加了胫骨-局部耻骨关节固定术的稳定性。我们提供了来自10个这样的程序的数据，平均随访期为10.9 +/- 5.4（6到20）个月，涉及10例患者（男9例，女1例）。病因是距骨和/或胫骨远端无血管性骨坏死，导致大量的空洞性骨缺损（8根脚踝），严重的白内膜挛缩（1根脚踝）和全踝置换失败（1根脚踝）。冷冻股骨头同种异体移植物使用两次，整个冷冻距骨同种异体移植物一次，冻干跟骨同种异体移植物一次。腓骨用腓总动脉的完整肌骨膜穿孔支链动员，作为用螺钉和垫圈构造固定的带血管蒂固定的骨移植物。腓骨平均移植长度为10.2 +/- 2.3 cm。放射线照相融合的平均间隔为2.6 +/- 0.6个月，负重的平均间隔为3.1 +/- 1.4个月。髓内钉硬件失效后，发生了两个稳定的大块同种异体移植物宿主骨和腓骨移植物宿主骨不愈合。当逆行加压髓内钉固定术稳定后，通过血管化的带蒂腓骨移植物增强的胫腓骨关节固定术可为复杂的抢救情况提供可靠的选择，而几乎没有其他选择。 （C）2016年，美国足踝外科医师学院。版权所有。

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