Treatment Of Segmental Defects Of The Tibia Using The Vascularized Fibula Combined With Autologous Bone-marrow

Objective:To explore the influence of autologous bone-marrow on morphological change of the vadcularized fibular graft and to find a relative ideal method for treatment of mass bone deficits of the tibia .Skeletal trauma, osteotumor, osteomyelitis, and congenital pseudarthrosis. To explore the best way of reserving for limbs with normal function extremely. Method:the fifty-nine patients with mass bone deficits in the tibia were treated with autologous bone_marrow combined with vascularizd fibular graft.Fifreen cases were involved as traumatic ostenomyelitis or osteomylitic seqesetration due to congenital pseudarthrosis.The eight cases were diagnosed as ostea-tumor and congenital pesudarthrosis.The eigt cases were diagnosed as osteo-tumor and congenital pseudarthrosis.The twenty-three patients were randomly divided into two groups,group A:autologous bone-marrow combined with vascularized fibula graft,and group B:simple vascularized fibula graft.1.surgical technique:Sequestruum with granulation and unsoud tissus were fist resected.Then,anterior tibal artery,great saphous vein was freed and contralateral fibular with vessel pedicle was harvested.After both ends of the harveted fibula with vessel pedicle were inlaid into proximal and distal tibial medullary and were fixed with screw .The both ends of the fibular artry were anastomosed to the both ends tibial artery off .It makes fibular artery bridge between the both ends of the fibular artery.The fibuar vein was anastomosed with same technique.The bone-marrow can be aspirated from the posterior iliac spine and was injected into the grafted fibular ends,and into the fibular subperiosteum with the points of the fibular myosleeves.Emphasis must placed on ensuring that aspirated bone-marrow contains a enough quantity of red bone marrow.For this reason,ti's no less than 2 cm between aspirated points. During operation and after four weeks procedure,percutaneuos antologous bone-marrow anpirated from the antero-superior orPostero-superior iliac iliac crest was injected at contacts between vascularized fibular guaft and tibia,and injected into subperiosteum with muscular sleeve of the vascularized fibular graft.Autologous bone-marrow were injected in 6weeks'and 12 weeks'times once and again.2.Curative evaluation:Untion velocity of the vascularized fibular graft and hypertrophic rate of vascuarized fibular grbular were involved as curative evaluation. (1)We assessed morpho-hypertrphic rate of the vascularized fibular graft by the methd of De Boer and Wood,using a graft morpho-hypertrophic index In,as: In=【(B2 /A2-B1/A1)/(B1/A1)】×100% Where:A1=graft diameter at proxmal junction at surgery B1=host bone diameter at proximal junction at surgery A2=graft diamcter at proximal junction at follow–up B2=host bone diameter at proximal junction at follow-up (2)The blood flow of the vascularized fibular grafts were examined by cobr Doppler flowmetry and/or angiography.Result:GroupA,vascularized fibular graft combined with autologous bone-marrow: Bone union was achieved in all pients.The mean time to follow-up was 76w(56w to 82w),graft untion took an average of 11w(9w to 13w),and morpho-hypertophic rate of the graft to a mcan of 30%(20%-50%)at the time of graft untion.At the time of mean follow-up,morpho-hypertrophic rate of the vascularized fibular graft:The avcrage length of follow-up 150%(120%~170%).Group B,simple vascularized fibular graft:The average length of follow-up was 96w(85w～112w).Union of the grafted fibula was showed to an avarage of 22%(20%～26%).At the time of a mean follow-up morpho-hypertrphic rate of the vascularized vascularized fibular graft was confirmed as a mean of 140%(100%～170%).The spss 10.0 method was used to compare the variables of two different groups,with chisquared and Student t-tests.A p calue of less thean 0.05 was considered to be statistieally signifieant. Tst lvel: a = O.05, t = 3.518, P