摘要
目的 探讨早期内固定联合穿支血管蒂皮瓣治疗前臂GustiloⅢB、ⅢC型开放性骨折合并软组织缺损的疗效.方法 回顾性研究2012年7月至2016年10月无锡市第九人民医院创伤骨科收治的45例Gustilo ⅢB、ⅢC型前臂开放性骨折患者资料,男26例,女19例;年龄20 ～ 61岁,平均41岁;GustiloⅢB型20例,ⅢC型25例;骨折AO分型：A型8例,B型21例,C型16例;创面大小4 cm×3 cm ～ 36 cm×8 cm.一期内固定＋二期穿支蒂皮瓣移植治疗33例,二期内固定联合穿支蒂皮瓣移植治疗12例.受伤至二期皮瓣覆盖时间为5～20 d,平均12d.其中股前外侧皮瓣36例,背阔肌皮瓣5例,上臂外侧皮瓣4例.结果 45例皮瓣均成活,其中2例背阔肌皮瓣远端部分坏死,后期切除后行植皮,1例股前外侧皮瓣术后血管危象发生,积极探查后远端约5 cm坏死.12例出现创面浅表感染,无深部感染及骨感染发生.所有患者均获随访,时间12 ～ 36个月,平均18.5个月.皮瓣质地柔软,有不同程度的色素沉着,皮瓣感觉恢复,其中S2 8例,S3 29例,S4 8例.5例供区瘢痕增生明显,其余40例无明显瘢痕增生.骨折愈合时间4～ 14个月,平均8.6个月;其中2例患者出现骨不连,于术后8个月行取自体髂骨植骨术.按Anderson评分标准评定疗效：优15例,良21例,可7例,差2例,优良率为80.0％.结论 早期内固定联合穿支血管蒂皮瓣修复前臂Gustilo ⅢB、ⅢC型开放性骨折伴软组织缺损可取得满意的临床效果,可以缩短治疗周期,早期功能锻炼,减轻患者痛苦,恢复肢体的外观及功能.
Objective To investigate the clinical therapy of early internal fixation combined with perforator flap for forearm open fractures of Gustilo types Ⅲ B ＆ Ⅲ C.Methods A retrospective study was conducted of the 45 patients with forearm open fracture of Gustilo type ⅢB or Ⅲ C who had been treated from July 2012 to October 2016 at Department of Traumatic Orthopaedics,The Ninth People＇s Hospital of Wuxi.They were 26 men and 19 women,aged from 20 to 61 years （average,41 years）.Twenty cases were Gustilo type ⅢB and 25 Gustilo type ⅢC.By AO classification,8 cases were type A,21 ones type B,and 16 ones type C.The wound size ranged from 4 cm × 3 cm to 36 cm × 8 cm.Thirty-three patients were treated by primary internal fixation plus secondary transfer with a perforator flap,12 ones by secondary internal fixation plus transfer with a perforator flap.The period from injury to secondary flap transfer ranged from 5 to 20 days （average,12 days）.In this series,36 anterolateral thigh perforator flaps,5 latissimus dorsal muscular flaps and 4 lateral arm flaps were transferred.Results All the 45 free flaps survived with no deep infection or osteomyelitis.Partial necrosis happened at the distal ends of 2 latissimus dorsal muscular flaps which were cured by skin graft.Postoperative circulatory crisis happened after transfer of an anterolateral thigh perforator flap which survived with 5 cm skin necrosis at the distal end after successful surgical exploration.Superficial wound infection happened in 12 patients with no deep or bone infection.All the patients were followed up for 12 to 36 months （average,18.5 months）.All the flaps were soft in texture,with varying degrees of pigmentation.The sensory recovery was S2 in 8 flaps,S3 in 29 flaps,and S4 in 8 flaps.Obvious scar hyperplasis was observed at the donor site in 5 cases while no obvious scar hyperplasis was observed in the other 40 ones.All the fractures got united after 4 to 14 months （average,8.6 months）.Nonunion happened in 2 patients who were treated with autologous iliac graft 8 months after operation.By Anderson criteria,the curative efficacy was assessed as excellent in 15 cases,as good in 21,as fair in 7 and as poor in 2,yielding an excellent to good rate of 80.0%.Conclusion Early internal fixation combined with perforator flap transfe is an effective strategy for treatment of forearm open fractures with soft tissue defects of Gustilo types Ⅲ B ＆Ⅲ C,due to its advantages of shortened treatment period,possibility for early rehabilitation,decreased complications and satisfactory functional recovery.
作者
芮永军
吴永伟
刘军
黎逢峰
马运宏
陆尧
康永强
周明
杨通
林芳
Rui Yongjun;Wu Yongwei;Liu Jun;Li Fengfeng;Ma Yunhong;Lu Yao;Kang Yongqiang;Zhou Ming;Yang Tong;Lin Fang(Department of Traumatic Orthopaedics,The Ninth People＇s Hospital of Wuxi,Wuxi 214062,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2018年第8期648-653,共6页
Chinese Journal of Orthopaedic Trauma
关键词
前臂损伤
骨折
开放性
骨折固定术
内
外科皮瓣
修复外科手术
Forearm injuries
Fractures
open
Fracture fixation
internal
Surgical flaps
Reconstructive surgical procedures
