Applied Research Of Nonvascularized Free Fibular Autografte In Repair Of The Massive Defect Of Bone

Objective: Defect of Bone is one of the common diseases of bone. The repair of large segmental bone defects due to trauma, infection and tumor surgery remains a major clinical problem. At present, Treatment methods of bone defects are mainly include:1. Autograft; 2. Allograft; 3. Bone substitute materials; 4. Membrane guided tissue regeneration; 5. Bone lengthening transfer; 6. Tissue engineering. Autogenous bone graft is the most traditional and effective treatment method of bone defects, and it has a clear advantage. In 1877, Albert was the first person who introduced the fibula as an alternative material for bone defect by congenital defect of the knee joints, and this method got to successful. At present, vascularized fibular graft was used with a widely range of applications. But when bone tumor was excision, or bone and joint were infected, there was wide range damage of bone and soft tissue. And severe soft tissue damage is associated with the organizational structure of local disorder. So it is difficult to find blood vessels in these soft tissues. The purpose of this clinical research in this group is to observe the treatment effectiveness of long bone defect by using non-vascularized autologous fibular graft association with internal and external fixation. It include regular follow-up, the analysis of imaging examination of graft bone healing, and the limb function score by Enneking system. To evaluate the feasibility of surgical method, this method could take treatment basis for the clinical by using of nonvascularized free fibula transplantation for treatment of large segmental bone defect.Methods: From February 2002 to December 2008, 3 cases infection and 12 cases bone tumor patients were treated with curettage focus of infection or resection for bone tumor in our hospital to perform non-vascularized autologous fibular grafts association with internal and external fixation for reconstruction of limb. These patients includ 9 males and 6 females. The defect length was from 8 to 19cm, (average 11.65cm). The fibular length was from 9.3 to 22.5cm, (average 15.41 cm). The age was from 5 to 55 years old, (average 27.53 years old). The follow-up time was from 12 to 106 months, ( average 27.33 months). The focus of diseases were included in 1 case of proximal humerus, 3 cases of distal radius, 4 cases of proximal tibia, 2 cases of middle tibia , 2 cases of distal tibia, 3 cases of distal femur. There were 3 cases of infection, 2 cases of benign tumor, 4 cases of borderline tumor, 6 cases of malignant tumor. Regular follow-up was done after operation. The item of follow-up included limb function reviewed by Enneking system, and the turnover of transplanted fibula evaluated by the vascularized autograft and radiological evaluation method. All the data were statistically analyzed by SAS V8.0 statistical software, the test the level byα= 0.05.Results: In this group, with an average follow-up of 27.33 months, 14 of 15 graft bone had bone healing, and 1 case had fibula fracture at 3 months post-operation due to trauma. Given plaster fixation , the fracture had bone healing at 6 months later.1 The limb functional of postoperative evaluationThis group patients'limb function recovered from 46.67% to 96.67%, with an average of 71.33%. The patients by reconstruction of wrist joint had normal appearance and the wrist joint function recovered well, with an average 80%. In the lower limb patients, affected limb length was next to opposite side. The knee joint functional activity recovery, which reserved knee joint surface, is better to the function of patients who had fusion of knee joint. The overall average function score was about 68.18%.2 The observation results of bone healing time by imaging examinationAccording to X-ray film shown by review, the group of all patients had bone healing about 9 to 20 weeks after transplantation of bone, with an average of 15.7 weeks. The upper limb bone healing time was about 11.5 weeks in average. The lower limb bone healing time was about 17 weeks average. According to reported , the vascularized fibular graft with the average healing time was about 14 weeks. Our effect compared to the literature, delayed for approximately 2 weeks.3 The correlation of length of bone graft and bone healing timeWe find that the increase in the length of bone graft need relative growth bone healing time.Conclusion:1 In the treatment of large bone defects (≥8cm), the non-vascularized autologous fibular graft is still a ideal method. Its benefits includ shorter operative time, less traumatic, simple, safe, easy-to-promotion approach .2 The bone healing process is similar to the corresponding parts bone fracture healing. The length of the graft bone has a certain correlation with healing time.3 For increasing bone contact area between the fibula and the bone marrow cavity by inserting fibula 1 ~ 2cm, the method can promote graft healing.4 There is no significant effect on internal fixation of the graft bone fractures. External fixation can prevent the occurrence of jiggle, and promote the healing of bone graft.5 In the long-term functional recovery of limb, there is no significant difference between nonvascularized autograft and the vascularized autograft.6 Early postoperative functional exercise have a positive effect on preventing muscle atrophy, joint stiffness, and promoting fracture healing and functional recovery.