血管柄付骨移植術症例の検討

Abstract

For past 7 years, we have performed vascularized bone graft on 28 patients. Nineteen of them were vascularized free bone graft, 7 were vascularized pedicle bone graft and 2 were combined operation of both vascularized free bone and pedicle bone graft. As a donor bone, 25 fibulae, 4 iliac bones and a rib were used.All of 10 cases except one of traumatic massive bone defect or pseudarthrosis, completed bone union. But in these cases, 2 needed conventional iliac bone grafting, because of delayed union due to unstable fixation of grafted bone. Four of 6 cases of avascular necrosis of the femoral head showed good X-ray appearance and clinical results. One case failed and another case is at a short time after operation to evaluate the result. In the cases of wide spinal lesions, spinal tuberculosis and neurofibromatosis, vascularized bone grafts were indicated. This procedure was used for limb salvage operations of malignant tumors of the tibia (adamantinoma), femur (osteosarcoma), and humerus (osteosarcoma, Ewing' sarcoma). Two cases of congenital pseudarthrosis of the tibia underwent free vascularized fibular graft. Both cases had additional operations: one required correction osteotomy and another patient needed Sofield procedure because of fatigue fracture. Vascularized bone graft was also used for arthrodesis, for example, of Charcot joint or infected joint in which the union of the bone was troublesome.