显微外科自体ffffa移植是修复儿童神经纤维瘤病大面积骨缺损的最佳方法

Q3 Medicine
S. I. Golyana, T. I. Tikhonenko, N. S. Galkina, D. Grankin
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The development of microsurgical methods enables to perform bone transfer of blood-supplied bone autografts.Purpose To prove the effectiveness of using microsurgical autologous transfer of the vascularized fibula for plastic surgery of bone defects in children with neurofibromatosis type I.Materials and methods A retrospective monocenter study included 27 pediatric patients who underwent reconstruction of bone defects with a vascularized fibular autograft from 2011 to 2021. The etiology of the bone defect in all patients was neurofibromatosis type I. A fibula graft was used to reconstruct 8 tibiae and 19 forearms. Bone defects averaged 12 cm. Median follow-up was 60 months.Results The fibula graft survival rate was 100 %. In 5 cases, nonunion of the proximal part of the fibula and the recipient zone was obtained which required iliac crest grafting. The overall rate of good and excellent results was 74 %. The average time to consolidation was 3 months. 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引用次数: 0

摘要

假关节和骨缺损是儿童I型神经纤维瘤病最常见的后果,这是一种罕见的遗传性疾病。骨组织的破坏会导致严重的畸形和肢体功能受损。这类患者的致残率可达70%。小儿此病的手术治疗是漫长、费力和多阶段的。传统的骨科治疗骨缺损的方法往往是无效的。显微外科方法的发展使供血自体骨移植的骨转移成为可能。目的探讨自体带血管腓骨显微外科移植在i型神经纤维瘤病儿童骨缺损整形手术中的有效性。材料与方法回顾性单中心研究包括2011年至2021年27例自体带血管腓骨移植重建骨缺损的儿童患者。所有患者骨缺损的病因均为i型神经纤维瘤病,采用腓骨移植物重建8条胫骨和19条前臂。骨缺损平均12厘米。中位随访时间为60个月。结果腓骨移植成活率为100%。5例腓骨近端与受骨区不愈合,需髂骨移植。总体优良率为74%。到盘整的平均时间为3个月。根据文献,在I型神经纤维瘤病患儿中,自体血管化骨碎片移植是一种非常有限的手术,因为它与并发症的风险增加有关。由于移植血管化自体移植物血流的恢复,它保留了其活力和骨组织重塑的可能性。结论带血管的腓骨碎片自体显微外科移植是治疗1型神经纤维瘤病儿童长骨缺损的一种有效且不可缺少的方法。大于5厘米的骨缺损提示需要自体游离移植带血管的腓骨碎片。这种方法与传统的骨科治疗方法相结合,可以获得良好的解剖和功能效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Microsurgical autologous ffbula transfer as an optimal method for closure of extensive bone defects in children with neuroffbromatosis
Introduction Pseudarthrosis and bone defects are the most common consequence of neurofibromatosis type I in children, a rare hereditary disease. Destruction of bone tissue leads to severe deformities and impaired function of the limbs. Disability in such patients may reach 70 %. Surgical treatment of children with this pathology is long, laborious and multi-stage. Traditional orthopaedic methods for managing bone defects are often ineffective. The development of microsurgical methods enables to perform bone transfer of blood-supplied bone autografts.Purpose To prove the effectiveness of using microsurgical autologous transfer of the vascularized fibula for plastic surgery of bone defects in children with neurofibromatosis type I.Materials and methods A retrospective monocenter study included 27 pediatric patients who underwent reconstruction of bone defects with a vascularized fibular autograft from 2011 to 2021. The etiology of the bone defect in all patients was neurofibromatosis type I. A fibula graft was used to reconstruct 8 tibiae and 19 forearms. Bone defects averaged 12 cm. Median follow-up was 60 months.Results The fibula graft survival rate was 100 %. In 5 cases, nonunion of the proximal part of the fibula and the recipient zone was obtained which required iliac crest grafting. The overall rate of good and excellent results was 74 %. The average time to consolidation was 3 months. Discussion According to the literature, the use of autografting of vascularized bone fragments is a ather limited procedure in children with neurofibromatosis type I as it is associated with an increased risk of complications. Due to the restoration of blood flow in the transferred vascularized autograft, it retains its viability and the possibility of bone tissue remodeling.Conclusion Microsurgical autologous transfer of a vascularised fragment of the fibula is an effective and at times indispensable method of bone plasty in long bone defects in children with type 1 neurofibromatosis. Bone defects larger than 5 cm are an indication for free autologous transfer of a vascularized fragment of the fibula. This method, used in combination with traditional orthopedic methods for the treatment of children, allows obtaining good anatomical and functional results.
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来源期刊
Genij Ortopedii
Genij Ortopedii Medicine-Surgery
CiteScore
0.70
自引率
0.00%
发文量
104
审稿时长
12 weeks
期刊介绍: Journal’s main goal is to contribute to the development of the contemporary medical science via presentation of fundamental and applied original scientific studies to the scientific and practical medical community that would widen and deepen the understanding of the most important problems in the field of traumatology, orthopaedics, and related specialties. Our journal provides a direct open access to its content which is based on the principle that the open access option promotes global exchange of knowledge and experience. Journal’s strategy: -Development of the journal as a scientific platform for researchers, doctors, post-graduates and residents -Attraction of highly-cited authors to publish their studies -Selection of manuscripts of scientific interest for readers that will impact on journal citation index in RINC -Increase in the portion of publications submitted by foreign authors and studies conducted in association with foreign scientists; growth of citations in the journals that are included into global systems of indexing and reputable databases -Improvement of the Journal’s web site in two languages for a greater accessibility by authors and readers -Introduction of the Journal into global indexing systems
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