Does Bone Scanning Predict Bone Union in Vascularized Bone Grafts?

利用腓骨皮瓣來進行一段骨頭缺損在近年來的手術是一種較為標準的方法。而對於術後的觀察，以往都是以外在皮瓣為主，並無法真正去瞭解骨頭存活與否，因此本研究的目的就是要以核醫的方法去預測骨頭細胞存活。從1993年至2001年，總共有27個骨頭缺損的病人接受腓骨皮瓣移植，有18個脛骨，7個大腿骨，1個橈骨，1個肱骨，骨頭缺損從6公分至15公分Tc-99的放射性物質用來評估移植骨的活性。有9位病人接受術前的核醫檢查，並定為標準值來與術後的移植骨做比較，而分為0至5，六種層級，X-光的檢查則是兩個月檢查一次來確定骨頭的癒合。所有27個病人中，4個病人評為等級0，3個病人為等級1，1個病人為等級2，8個病人為等級3，9個病人為等級4，2個病人為等級5，等級0的骨頭癒合時間（17個月）明顯比等級1至4的時間長。除了外在皮瓣存活外，三相核子掃描檢查確實可預測帶莖血管移植骨的癒合。

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Using a free fibula osteoseptocutaneous flap for a segmental long defect is the standard technique in recent reconstructive surgery. For postoperative monitoring of vascular patency, an overlying skin flap is useful. However, does the skin paddle of a fibula osteoseptocutaneous flap really reveal the real state of vascularized bone grafts? Between 1993 and 2001, 27 segmental bony long defects were reconstructed with fibula osteoseptocutaneous flaps. The defects were 18 in the tibia, 7 in the femoral, and one in each of the radius and humerus. The defects ranged from 6- to 15-cm. All of the vascularized fibula grafts were inserted into the bone marrows of the recipient bones as inlayed grafts with rigid fixations. Technetium-99 methylene diphosphate (MDP) bone scans were used to assess the viability of the transplanted fibula. It was performed to the donor legs one week preoperatively in nine normal patients to serve as the baseline for comparison with bone scans performed one week postoperatively. Intensity of phase three (delayed bone image) was graded from 0 to 5. Plain X-rays of the recipient limbs were taken at two-month intervals for assessment of bone union. In this series, all 27 skin flaps were clinically judged viable. In Tc-99 bone scan studies, 4 patients were rated as grade 0, 3 patients were grade 1, one patient was grade 2, 8 patients were grade 3, 9 patients were grade 4, 2 patients were grade 5. The bone union time between grade 0 and grade 1, grade 0 and grade 3, grade 0 and grade 4, was statistically significant difference (Mann-Whitney Test) (p＜0.05). The grade zero group the average union time was around 17 months, longer than the expectation. In spite of outer viable skin flaps, phase three bone scan is valuable to predict bone union time, because it is the better way to estimate the viability of osteocytes of vascularized bone grafts.

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