上海第六人民医院幻灯模板医学课件.ppt

Free vascularized ?bular grafting combined with a locking plate for massivebone defects in the lower limbs You-Shui Gao, Chang-Qing Zhang Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai, China Background Massive femoral and tibial defects due to severe trauma, osteomyelitis and resection of malignancies present challenging problems for orthopedic surgeons. As an alternative, distraction osteogenesis using the Ilizarov technique has proved of great significance in manipulation of massive bone defects. However, complications following the sophisticated technique are not negligible, treatment duration is long, and much inconvenience is caused by the complex external fixators. Free vascularized fibular grafting (FVFG) could be a good option for the restoration of massive bone defects in lower limbs. However, post-op complications could be reach 54% following FVFG, and graft fracture is significant with traditional stabilization. Then, how to promote the functionality of transplanted fibula? how to prevent secondary complications? Arai K, et al. PRS 2002. A locking plate, which has been well described in the published literature, achieves advances in angular stability, integrity of screws and plate, and elastic stabilization. The locking plate systems possess improved mechanical properties and include newly designed screws to anchor the plate system firmly in the bone while exerting compression. Dynaminization of the bone-plate construct Hypertrophy of the transplanted fibula Patients and Methods Eighteen patients with a massive bone defect in a lower limb reconstructed by FVFG combined with a locking plate were retrospectively enrolled in the current study. The degree of fibular hypertrophy was calculated based on the measurements from anteroposterior imaging at regular intervals of 3 months, 6 months, 1, 2 and 3 years postoperat