处截骨骨搬移治疗胫骨.pptxVIP

Bilocal Osteosynthesis for Large Segmental Defects of the Tibias and Skin二处截骨骨搬移治疗胫骨大段骨和软组织缺损Combined large defects of bone and skin of the leg remains to be a great challenge！Traditional treatments:Microsurgical treatment or Ilizarov principles External fixation with flap transfer with bone graftsFree fibulas flapMonolocal osteosynthesis长节段的复合骨和软组织缺损依旧是治疗难题传统的方法：显微外科技术或ILIZAROV技术外固定合并皮瓣合并植骨游离腓骨皮瓣单处截骨延长Let’s Review These techniques……Free flap transfer combined with external fixations 吻合血管的游离皮瓣与外固定架联合CASE 1Free thoracoumbilical flapCASE 2Free thoracoumbilical flapCASE 3CASE 4Free thoracoumbilical flapCASE 5Monolocal osteosynthesis一处截骨CASE 1CASE 2CASE 3Boy, 6 ysLong segmental defectsAfter flap transfer and skin grafts. 2 years later CASE 4After local flap transfers CASE 6One-stage flap transfer and Distraction Osteosynthesis一期皮瓣转移和延长CASE 7 Free ALT Perforator flap But non-unionWhy do we chose bilocal osteosynthesis?我们为何选择两处截骨？External fixation combined with flap transfer and bone grafts---good for small segmental defects, requires microsurgical expertise.Free fibulus flap---good for children and adolescens, not suitable for adults (re-fractures), requires microsurgical epertise.One-stage shortening and distraction osteosynthesis---only for short bone defectsOne-site (monolocal) osteosynthesis---too slow 外固定架与皮瓣联合植骨术---可以治疗小段骨缺损，对于大段长骨干缺损，则难以找到满意的替代骨；要求显微外科技术。对侧吻合血管的腓骨皮瓣移植，对于儿童和青少年，移植后的腓骨容易增粗塑形成胫骨，但对于成年人，塑形和增粗效果不佳，容易导致移植腓骨再骨折；要求显微外科技术。一期短缩加延长对于小于5cm的骨和软组织缺损较为满意，对于更长的骨缺损，由于短缩处形成皮肤皱褶，容易导致肢体血运障碍；单纯干骺端截骨延长进行骨搬移，临床最为常用，但按照目前的理论，每天的延长速度不能超过1mm，因而总体延长时间依然较长。Bi-local osteosynthesis二处截骨2009-20116 casesMale, 20-51 ys, Gustilo IIIB fractures.Soft tissue defects: 11 cm×24 cm~4 cm×8 cmTibia defects: 8~18 cm。2009年5月-2011年5月，收治胫骨大段骨缺损合并软组织缺损患者6例。均为男性，年龄20~51岁，平均34.5岁。均为开放性骨折（Gustilo IIIB型); 小腿胫前软组织缺损最大11 cm×24 cm，最小4 cm×8 cm.胫骨骨缺损8~18 cm。Tips of surgery1 Total removal of dead tissue2 Electric drill for holes, then chisel for osteotomy3 Local flap coverage of the exposed bone remnants