[摘要]：目的 设计一种新的治疗Gustilo Ⅲ型胫骨远端骨折的组合移植方法。方法 1998年10月～2008年11月对46例Gustilo Ⅲ型胫骨远端骨折进行逆行比目鱼肌+骨膜附皮质骨瓣组合移植手术，包括 Gustilo Ⅲa型16例，Ⅲb型30例。男29例，女17例，年龄23～77岁，平均36岁。手术方法：骨折固定完成后，显露比目鱼肌内侧半在胫骨上端附着点，骨膜连同胫骨表面薄层皮质骨片一并切取, 比目鱼肌连同骨膜薄层皮质骨片向下翻转覆盖骨与软组织缺损处固定。结果 随访时间30月～46月，平均26月。46个病例9例取髂骨植骨；其余只采用骨膜附皮质骨瓣移植。骨愈合时间18~37周，平均为22周。外固定钉道感染1例。患肢踝关节活动正常及接近正常38例，关节受限8例。41例手术后恢复原工作，5例改变工作。全部病例行走正常，5例感觉跑步时后蹬力不足。结论 逆行比目鱼肌骨膜附皮质骨瓣移植治疗创伤性胫骨远端骨与软组织缺损是可行有效的方法，Ⅰ期组合移植方法简单，可同时重建骨与软组织缺损，促进骨折愈合。
Repairing bone and soft tissue defects in distal tibia with retrograde soleal muscle flap with Osteoperiosteal Decortication
WU Wei-ping (Dept of Orthopaedics, 10th Hospital, Tongji University, Shanghai 200072 China)
[Abstract] Objective: To explore the feasibility of repairing bone and soft tissue defects in distal tibia with retrograde soleal muscle flap with periosteum-cortex bone. Methods: From June 1998 to September 2008, 46 cases were treated with retrograde soleal muscle flap with periosteum-cortex bone to repair traumatic bone and soft tissue defects in distal tibia, in which 16 cases were classified in Gustilo Ⅲa, and 30 cases Gustilo Ⅲb. 29 cases were males and 17 were females. The average age was 36 years (range, 23-77 years). After incised in the middle of leg, the median adhesion of soleus to proximate periosteum of tibia was cuted out and incised according to bone defect. In the same time , a layer of cortical bone uniformly adhering with periostuem was chiseled with sharp osteotome. The fracture fixation had been done before the cortical bones were as a 1-2 mm slice of fish. Soleus medial head was turned over 8-10mm superior to medial malleolus ,and the defects of bone and soft tissue were covered. We fixed the periosteum of the cortical bone in the bone defect with absorbable suture and used the muscle lap to cover the soft tissue defect which had incised in the perpendicular median line of soleus and ligated posterior tibial artery to soleus.Results: All cases were followed up for 26 months in average ( ranged from 30 to 46 months), 9 cases of all were applied with bone grafts . All incisions had healed well with no infections of bone and soft tissue. The mean time of bone union was 22 weeks( ranged from 18 to 37 weeks). The ankle joint movement of 38 cases were returned to a normal or nearly normal status , but 8 cases were limited. 41 cases returned to be engaged in their pre-injury occupations, howerver, 5 patients changed. All patients walked well after operation, but 5 patients felt powerless when running. Conclusions: Retrograde soleal muscle flap with periosteum-cortex bone is a feasible and effective method to repair bone and soft tissue defects in distal tibia. The periosteum-cortex bone grafting involves both the periosteum and the cortex-bone. The grafting with bone and soft tissue is easy to perform, and the bone union is accelerated.