Juvenile Metacarpal Bone Missing: Reconstruction by Free Vascularized Iliac Bone Graft Including Its Cartilage for Bone Growth Consideration

兒童掌骨損傷(Juvenile Metacarpal Bone Missing)－腸骨自由骨皮瓣重建，含軟骨以供生長

賴釗毅(Chao-Yi Lai) ； 莊垂慶(David Chwei-Chin Chuang)

《中華民國整形外科醫學會雜誌》 17卷1期 (2008/03) Pp. 65-72

https://doi.org/10.7096/JPSA.200803.0065

摘要

背景：手部嚴重壓砸傷可能會造成掌骨甚至腕骨之損傷，這在重建上是一大考驗，尤其在小孩子，必須兼顧外觀，功能和生長。腸骨自由骨皮瓣大部份用在股骨頭壞死，下頜骨缺損，脛骨骨髓炎，舟狀，月狀等腕骨的重建，但沒有重建兒童掌骨之缺損的研究報告。以下是我們的兩個病例報告，而且都在門診做過長期的追蹤。
方法：這個研究總共包含兩個病例。其中一個是7歲的女孩因右手接觸性灼傷及壓砸傷，造成右手第二至第五掌骨缺失。另一個病例是個7歲的男孩因右手嚴重壓砸傷，造成右手第四及第五掌骨及幾乎全部的腕骨缺損。這兩個病例都接受腸骨自由皮瓣顯微重建手術。這兩位病人都在門診追蹤並且規則測量骨骼的長度至少5年。
結果：兩位病人都得到功能上的進步及可接受的外觀。同時，這兩位病人移植的腸骨都有生長的情形，其中女孩的移植腸骨平均每年在長度上增加1.07mm，在寬度上增加0.94mm；而男孩再長度上每年增加1.69mm，在寬度上增加1.40mm。雖然如此，但其生長的速度仍然比正常骨骼緩慢。
結論：根據我們的結果，用腸骨自由骨皮瓣進行兒童掌骨或腕骨缺損的重建是可行且適當的方法，但由於生長的速度比正常骨骼緩慢，因此我們建議在取腸骨自由骨皮瓣時體積應比從正常側測量所預期的還大，並且應多包含一些腸骨脊上的軟骨及硬骨。

並列摘要

Background: Severe crush injury to hand may lead metacarpal bones even carpal bones loss and reconstruction for this injury especially in growing children was a great challenge on shape, function and growth concerns. Vascularized iliac bone graft was mostly used in femoral head necrosis, mandibular defect, tibial osteomyelitis, scaphoid or lunate carpal bone reconstruction, but no report for metacarpal bones missing reconstruction. We here report our experience in 2 cases with a long-standing follow-up.
Method: Two cases are in this study. One is a 7 year-old girl suffering from compression and contact burn injury over right hand with 2nd to 5th metacarpal bones loss. The other is a boy with same age suffering from right hand crushing injury with 4th and 5th metacarpal and almost all carpal bones loss. Both received free vascularized iliac osteocutaneous flap for reconstruction. Both have at least 5 years follow-up. Bone length was measured regularly in the clinics.
Result: Both patients got acceptable function and appearance. The girl patient had 1.07mm in length and 0.94mm in width and the boy patient had 1.69mm in length and 1.40mm in width of yearly iliac bone growth ini the traumatized hand. The transferred iliac bone graft is growing but slower than the normal hand growing.
Conclusion: Although free vascularized iliac bone graft might be a suitable choice of reconstruction for child patient with missing metacarpal and/or carpal bones, further improvement including more iliac crest cartilage and more iliac bone harvest than the measurement from the non-traumatized hand should be considered in the next similar cases.

並列關鍵字

juvenile metacarpal bone missing ； free vascularized iliac bone graft