摘要
目的 探讨一期内固定联合皮瓣移植治疗下肢GustiloⅢB型开放性骨折并严重软组织缺损的效果. 方法 2008年1月至2013年1月,采用一期内固定联合皮瓣移植治疗下肢GustiloⅢB型开放性骨折并严重软组织缺损病例共15例.骨折部位足踝部2例,胫、腓骨下段9例,上段3例,股骨远端l例;皮瓣面积l0.0cm×8.0cm～28.0cm×16.0cm;骨缺损植骨6例,缺损1.0～4.0 cm,均取髂骨植骨. 结果 术后随访6 ～ 24个月,皮瓣全部成活,仅2例皮瓣远端小面积坏死,经换药等治疗自行愈合;创面渗液感染1例,经抗感染、引流治疗后二期愈合;13例骨折顺利愈合,延迟愈合2例,二期行植骨术后均愈合,愈合时间平均7.2个月,无1例发生骨髓炎;创面愈合时间12～ 36 d,平均18.1 d.采用下肢功能评价表评价下肢功能,优良率86.6％. 结论 一期内固定联合皮瓣移植治疗下肢GustiloⅢB型开放性骨折并严重软组织缺损,是安全有效的策略,且具有骨折固定可靠、创面覆盖满意、早期恢复功能锻炼、缩短治疗周期、减轻患者痛苦等优点.
Objective To investigate the clinical effect of primary internal fixation combined with flap transfer for Gustilo Ⅲ B open fracture of lower extremity with severe soft tissue defct.Methods From January,2008 to January,2013,15 patients with Gustilo Ⅲ B open fracture of lower extremity and severe soft tissue defect were treated with primary internal fixation combined with flap transfer.Among them,there were 2 cases of foot and ankle fracture,9 of lower-tibia and fibula,3 of upper-tibia and fibula and 1 of distal femur fracture.The areas of the flaps were 10 cm × 8 cm-28 cm × 16 cm.Three cases were treated by bone grafting because of bone defect.Results All patients were followed up for 6-24 months.All flaps were survived,and only small area of 2 cases with the distal necrosis were cured by changing the dressing; In 1 case,the wound was infection and healed after anti-infective and drainage treatment; 13 cases had bone union in primary stage,and the other 2 cases were achieved delayed union; the average healing time was 7.2 months,and no case of osteomyelitis was noted; the time of wound healing was 12-36 days,with an average of 18.1 days.According to lower extremity function evaluation form,the excellent and good rate was 86.6%.Conclusion It is a safe and effective strategy to treat the Gustilo Ⅲ B open fractures of lower extremity and severe soft tissue defect with primary internal fixation combined with flap transfer,which has advantages of reliable fixation,covering the wounds with satisfaction,recovering exercise early,shorten the treatment period,alleviating the suffering of patients and so on.
出处
《中华显微外科杂志》
CSCD
北大核心
2014年第6期560-563,共4页
Chinese Journal of Microsurgery
