摘要
目的回顾性分析前中足碾挫伤患者的损伤特点、手术方式选择、并发症及治疗效果。方法 2002年5月至2009年10月手术治疗14例足部碾挫伤患者,男12例,女2例;年龄14～69岁,平均34.6岁。14例患者均为碾压伤。中足骨折脱位5例,前足骨折脱位4例,前中足骨折脱位5例。合并糖尿病2例,动脉闭塞1例。初次清创后,皮肤软组织缺损面积3 cm×3 cm以下9例,采用一期缝合或换药+植皮;缺损面积3 cm×3 cm以上5例,行二期转移皮瓣覆盖创面。神经/血管/肌腱吻合或移植5例。切开复位接骨板固定5例,克氏针螺钉固定5例,石膏或支具治疗2例,另2例行截肢术。围手术期并发症包括:皮缘坏死1例,皮瓣坏死1例,深静脉血栓1例,筋膜室综合征1例。结果 13例获得随访,随访时间6～29个月,平均15个月。功能恢复满意11例。结论足部碾挫伤是足部骨、关节及皮肤软组织的严重复合损伤。治疗应重建足弓的负重结构,如能解决软组织覆盖问题,内固定不是绝对禁忌证。多科室协作有利于早期康复。
Objective To analyze the characteristics of injury,selection of operative methods,complication and outcomes of anterior and middle foot contusion.Methods Totally 14 severe foot contusion cases were reviewed from May 2002 to October 2009.There were 12 males and 2 females with an average age of 34.years（range,14-69 years）.The classification of fracture or dislocation,soft tissue deficits,operative methods and peri-operative complications were evaluated. Results Five cases suffered of middle foot fracture and dislocation,4 cases in anterior foot,and 6 cases in anterior and middle foot.Two cases combined with DM and one with artery occlusion.After primary debridement,5 patients＇ skin deficits exceeded 3cm×3cm,and underwent flap transplantation.Two patients underwent amputation,and 5 patients with nerve,vascular or tendon problems treated operatively.Five patients were treated with plates and screws,5 with Kirschner wires,and 2 with plaster.Complications include one case of would necrosis,one flap necrosis,one DVT and one compartment syndrome.In 15 patients who had been followed up over 6 months,11 had excellent or good function. Conclusion Severe anterior and middle foot contusion is a compound injury concerning bone,joints and skin and other soft tissues.The therapy aim is to reconstruct the weight bearing structure of the foot and the soft tissue coverage. Internal fixation is not absolute contraindication.Cooperation is propitious to early recovery.
出处
《中国骨与关节外科》
2010年第3期215-218,共4页
Chinese Journal of Bone and Joint Surgery
关键词
前中足
碾挫伤
内固定
并发症
Foot
Contusion
Internal fixation
Complication
