血管柄付き腸骨移植とイリザロフ創外固定器を併用した著しい関節破壊を伴う足関節に対する治療の2例

抄録

  Two cases of severely injured ankle joints were successfully treated with vascularized iliac bone grafting and Ilizarov external fixator. The first case was due to persistent ankle tuberculosis. The second case was caused by collapse of the talus after total ankle arthroplasty. In both cases, there were serious bone defects after debridement of a large amount of diseased tissue surrounding the ankle joint. For delivery of antibacterial drugs through healthy vascularized bone in the first patient, and for augmentation of healthy bone stock to the collapsed talus in the second patient, a vascularized iliac bone transfer was performed. Ilizarov fixator was used for postoperative immobilization and early weight bearing without negative influence to the grafted bone. As a result, the grafted bones successfully survived and bone unions were achieved in both patients. Since vascularized iliac bone graft has a rectangular shape and rich cancellous bone, it is a very good candidate for use in devastating bone defects of the ankle joint. Further, combination with Ilizarov fixator enables the patient to bear weight in the early postoperative phase.