Pedicled Vascularized Rib Transfer for Reconstruction of Clavicle Nonunions with Bony Defects: Anatomical and Biomechanical Considerations
Pedicled Vascularized Rib Transfer for Reconstruction of Clavicle Nonunions with Bony Defects: Anatomical and Biomechanical Considerations
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带蒂血管化肋骨移植重建有骨缺损的锁骨骨不连：解剖学和生物力学考虑
DOI：
10.1097/01.prs.0000263537.57701.8b
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发表时间：
2007
影响因子：
3.6
通讯作者：
C. Dumont
中科院分区：
文献类型：
--
作者：
C. Werner;P. Favre;Harry G. van Lenthe;C. Dumont
工作背景：锁骨大面积骨缺损的骨不连虽然罕见，但很难治疗，通常是由于多次手术治疗失败所致。在大面积骨缺损的病例中，使用带血管骨移植重建是公认的标准。研究方法：通过尸体解剖和有限元分析进行解剖学血管腐蚀研究，旨在评估基于带蒂前锯肌瓣的肌骨移植物间置重建锁骨的可行性。结果如下：通过前锯肌的肋骨血管化被证明，因此胸背动脉的胸分支可以被认为是第七和第八肋骨的二级血液供应。单和双蒂肋骨转移允许重建多达8厘米的骨丢失。在单肋骨重建界面中发现的最大应力位于接骨板与锁骨的内侧接触处。它是完整锁骨内侧弓最大应力的2.7倍。相反，双肋骨重建提高了机械阻力。使用单肋骨转移的病例报告支持生物力学研究，显示材料松动的最大风险位于内侧骨界面。结论：对于锁骨大面积缺损，应采用带血管蒂的双肋骨移植代替单肋骨移植。这种技术是可重复的，不需要微血管栓塞。与游离腓骨移植相比，具有潜在的优越性。
Background: Clavicular nonunions with large bony defects, although rare, are difficult to treat and often result from multiple failed attempts at surgical management. Reconstruction using vascularized bone graft is the accepted standard in cases of large osseous defects. Methods: An anatomical vascular corrosion study with cadaveric dissections and finite element analyses was designed to assess the feasibility of clavicular reconstruction with a musculo-osteous graft interposition based on a pedicled serratus anterior flap. Results: Rib vascularization through the serratus anterior was demonstrated, so that the thoracic branch of the thoracodorsal artery can been considered a secondary blood supply for the seventh and eighth ribs. Single and double pedicled rib transfers allowed for reconstruction with as much as 8 cm of bone loss. The maximal stress found in the single-rib reconstruction interfaces was located at the medial contact of the plate with the clavicle. It was 2.7-fold higher than the maximal stress of the medial bow of the intact clavicle. Conversely, the double-rib reconstruction had improved mechanical resistance. A case report using a single-rib transfer supported the biomechanical study by showing that the maximal risk of material loosening was located at the medial bone interface. Conclusions: Double vascularized rib transfer as part of a serratus anterior flap should be used instead of single-rib transfer to reconstruct large clavicle defects. This technique is reproducible and does not require microvascular anastomoses. Therefore, it has potential advantages over free fibula transfer.
DOI：
10.1115/1.2895534
发表时间：
1993-11-01
影响因子：
1.7
作者：
HUISKES, R;HOLLISTER, SJ
通讯作者：
HOLLISTER, SJ