摘要
目的 探讨GustiloⅢB、ⅢC型小腿及足踝部开放性骨折一期修复与重建的临床疗效及手术要点.方法 回顾性分析2001年1月至2012年4月收治的160例GustiloⅢB、ⅢC型小腿及足踝部开放性骨折患者,男103例,女57例;平均年龄为36.3岁.骨折部位及Gustilo分型：胫骨干1 13例（ⅢB型91例,ⅢC型22例）,胫骨远端4例（ⅢB型3例,ⅢC型1例）,足踝部43例（ⅢB型37例,ⅢC型6例）.受伤至手术时间为3～37 h,平均12.7h.彻底清创后应用穿支皮瓣、皮神经营养血管皮瓣、传统轴型皮瓣及肌皮瓣、局部皮瓣一期修复关键创面,选择外固定支架（121例）、钢板（20例）、螺钉或克氏针（14例）及髓内钉（5例）确定性固定骨折,同时完成其他必要的肢体结构及功能重建.结果 本组患者平均住院时间为28.0 d（9 ～76 d）,关键创面均经初次手术获得修复.除1例GustiloⅢC型胫腓骨骨折患者因主诉伤肢持续性疼痛而截肢外,其余159例保肢成功患者术后获12～ 83个月（平均21.3个月）随访.随访期间均未发生严重或持续的骨感染,骨性愈合时间为6～19个月（平均11.7个月）,肢体功能、外形恢复满意.结论 应用标准的修复重建外科技术及骨折固定技术一期修复与重建GustiloⅢB、ⅢC型小腿及足踝部开放性骨折可显著缩短治疗周期,减少并发症;新鲜创面解剖清晰,手术更为灵活;仅修复关键创面可减少供区牺牲,避免外形臃肿.
Objective To explore one-stage reconstruction of open fractures of leg,ankle and foot of Gustilo types Ⅲ B and ⅢC.Methods From January 2001 to April 2012,160 open fractures of leg,ankle and foot of Gustilo types Ⅲ B and Ⅲ C were treated with one-stage reconstruction.They were 103 men and 57 women,with an average age of 36.3 years.There were 113 cases of tibial shaft fracture （type ⅢB in 91 and type ⅢC in 22）,4 cases of tibial distal end fracture （ⅢB in 3 and type ⅢC in one）,and 43 cases of ankle and foot fracture （ⅢB in 37 and type ⅢC in 6）.Time from injury to surgery ranged from 3 to 37 hours,averaging 12.7 hours.After thorough debridement,crucial soft-tissue wounds were covered with surgical flaps,such as perforator flap,neurovascular flap,traditional axial skin or muscular flap and even local flap.The fractures were reduced and fixated definitively using external frames in 121 cases,plates in 20 cases,screws and/or K-wires in 14 cases,and intramedullary nails in 5 cases.Other limb reconstructions included neurovascular repair,transposition of the tendon and nerve,and joint stabilization of ankle and foot.Results Mean in-hospital time was 28.0 days （ranged from 9 to 76 days）.Crucial wounds were repaired primarily.The limbs were savaged successfully in 159 cases while amputation was performed in one case of tibiofibular fracture of Gustilo type Ⅲ C 2 months after primary operation because of consistent and severe pain.Follow-ups ranged from 12 to 83 months （average,21.3 months）.No severe or persistent infection occurred and bone union time ranged from 6 to 19 months （average,11.7 months） with satisfactory aesthetic and functional results.Conclusions One-stage reconstruction of open fractures of leg,ankle and foot of Gustilo types Ⅲ B and Ⅲ C with standard techniques of plastics and fracture management can significantly simplify the procedures and reduce complications.In addition,fresh wounds are easier to get repaired.Moreover,flap coverage of only crucial defects but not the whole wounds can minimize donor sacrifice and recipient bulking.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2014年第11期939-945,共7页
Chinese Journal of Orthopaedic Trauma
