探讨应用自体带血管蒂腓骨移植治疗股骨感染性骨缺损的临床疗效。

回顾性分析自2018年1月至2022年1月兵器工业总医院创伤骨科收治的 11例股骨感染性骨缺损患者的病例资料，其中男 8例，女3例，平均年龄（34.0±4.5）岁，平均骨缺损长度（9.5±1.7） cm。术中对骨缺损端彻底清创后固定股骨，切取自体带血管蒂腓骨复合组织瓣行一期重建。游离并修剪腓骨血管蒂后，将其与受区血管实施端侧吻合。其中5例采用单段腓骨移植，6例采用双段腓骨移植，平均移植腓骨长度（14.5±3.2） cm，采用钢板或外固定支架固定带血管蒂腓骨。术后常规予以抗感染、抗凝及抗血管痉挛治疗（抗感染治疗疗程 4~6 周，抗凝及抗血管痉挛治疗持续 2 周），密切观察感染控制情况及带血管蒂腓骨成活状态；通过复诊影像学检查随访评估带血管蒂腓骨与受区结合处的愈合情况，指导患者行下肢功能锻炼，并根据Enneking评分、Baird-Jackson踝关节功能评分、Ilizarov技术研究与推广学会（ASAMI）评价标准及下肢功能量表（LEFS）评分评估患肢与供区愈合情况及肢体功能。

11例患者均获得随访，平均随访时间（24.5±12.8）个月。所有患者伤口均一期愈合，无感染复发，带血管蒂腓骨均成活，无血管危象发生，供区未出现明显功能障碍。所有移植的带血管蒂腓骨均获得稳定骨性连接，无骨吸收、骨质硬化及再骨折等并发症，平均骨性愈合时间（5.5±1.2）个月。术后 12个月，患肢平均 Enneking 评分（24.0±3.3）分，供区平均 Enneking 评分（27.2±1.1）分，供区平均 Baird-Jackson踝关节功能评分（95.5±1.6）分；末次随访时，患肢 ASAMI 评价结果显示11例患者骨评价均为优，功能评价优7例、良4例，患肢平均LEFS评分（75.5±2.2）分。

应用带血管蒂腓骨移植及血管重建有助于改善局部血运、控制感染，能有效修复大范围股骨感染性骨缺损，提高骨愈合率，是该类疾病临床治疗的有效手段。

To explore the clinical efficacy of autologous vascularized fibula flap transplantation for the treatment of infectious femoral bone defects.

A retrospective analysis was conducted on the clinical data of 11 patients with infectious femoral bone defects treated in the Department of Orthopedic Trauma， Norinco General Hospital from January 2018 to January 2022. There were 8 males and 3 females， with an average age of （34.0±4.5） years and an average bone defect length of （9.5±1.7） cm. During surgery， after thorough debridement of the bone defect ends， the femur was fixed. An autologous vascularized fibula composite tissue flap was harvested for one-stage reconstruction. The vascular pedicle of the vascularized fibula was anastomosed to the recipient vessels via end-to-side technique after isolating and trimming the vascularized fibula. Among them， 5 cases were repaired with a single fibula graft， and 6 cases were repaired with a two-segment fibula graft， with an average transplanted fibula length of （14.5±3.2） cm. The vascularized fibula was fixed with plates or an external fixator. Postoperatively， routine anti-infection， anticoagulation， and antivasospasm treatments were administered （anti-infection treatment course lasted 4-6 weeks， and anticoagulation and antivasospasm treatments lasted for 2 weeks）. Infection control and vascularized fibula survival were closely observed. The healing status at the junction of the vascularized fibula and the recipient site was evaluated by follow-up radiological examinations during reconsultations. Patients were instructed to perform lower limb functional exercises， and the healing conditions of the affected limb and donor site， as well as limb function， were evaluated using the Enneking score， Baird-Jackson ankle function score， association for the study and application of the method of Ilizarov （ASAMI） criteria， and lower extremity functional scale （LEFS） score.

All 11 patients were followed up， with an average follow-up time of （24.5±12.8） months. All wounds healed primarily without infection recurrence， all vascularized fibula survived with no vascular crisis observed， and there was no significant functional impairment at the donor sites. All transplanted vascularized fibula achieved stable bony union， without bone resorption， osteosclerosis， or refracture. The average time to bony union was （5.5±1.2） months. At 12 months postoperatively， the average Enneking score of the affected limb was （24.0±3.3） points， the average Enneking score of the donor site was （27.2±1.1） points， and the average Baird-Jackson ankle function score of the donor site was （95.5±1.6） points. At the final follow-up， ASAMI criteria assessment of the affected limb showed excellent bone results in all 11 patients， with 7 cases of excellent functional results and 4 cases of good functional results. The average LEFS score of the affected limb was （75.5±2.2） points.

The application of vascularized fibula transplantation and vascular reconstruction helps improve local blood supply and control infection， can effectively repair large-scale infectious femoral bone defects， and improve the bone healing rate. It is an effective clinical treatment for this type of disease.