摘要
目的探讨下肢GustiloⅢB型、Ⅲc掣歼放性损伤的保肢治疗方法及其疗效，方法2008年10月至2012年1月共收治82例下肢GustiloⅢB型、ⅢC型骨折患者，男64例，女18例；年龄21～64岁，平均45．3岁。骨折Gustih，分型：ⅢB型63例，ⅢC型19例.骨折折部位：胫腓骨37例，胫骨6例，股骨9例，双侧胫腓骨5例，胫腓骨合并股骨11例，胫腓骨合并跖趾骨14例。肢体创伤严蘑程度评分：〉7分29例，6～7分32例，〈6分21例。均采用负压封闭引流（VSD）技术和延期组织瓣修复的保肢策略治疗．创面最终覆盖方式：直接缝合4例，植皮13例，肌瓣移植16例，局部或交腿筋膜瓣移植41例，游离皮瓣移植4例。结果82例患学术后获4～53个月（平均17个月）随访。78例患者保肢成功，4例（GustiloⅢB型、ⅢC型各2例）患者行二期膝下截肢术。保肢成功的78例患者平均负压吸引1．6次，平均于术3．7次。骨折一期愈合66例，愈合时间平均为6．4个月；延迟愈合7例；骨不连5例。9例患者出现创面感染现象，3例发生慢性骨髓炎。结论对于下肢GustiloⅢB型、ⅢC型骨折患者，通过彻底清创及合理骨折固定，配合VSD技术及延期组织瓣修复，可有效恢复肢体功能．．
Objective To explore the clinical skills and outcomes of limb-salvage surgery tor Gustilu m B and m c fractures in the lower limb. Methods From October 2008 to January 2012, 82 patients with Gustilo Ⅲ B and Ⅲ C fractures in the lower limb were treated in our hospital. They were 64 men and 18 women, aged 21 to 64 years （45.3 years on average）. There were 63 cases of Gustilo Ⅲ B fractures and 19 eases of Custilo H1C fractures. The fi＇actures involved the tibiofibula in 37 cases, the tibia in 6, the femur in 9, the bilateral tibiofibula in 5, the tibiofibula and femur in 11, and the tibiofibula and metatarsophalangeal bones in 14. Bv the maugled extremity severity score （MESS） system, 32 patients scored from 6 to 7 points, 21 below 6 points and 29 above 7 points. The treatment included debridemeul, skeletal reennstruction, vac- uum sealillg drainage （VSD） and delayed flap reconstruction. For definitive wound coverage, 4 wouuds re- ceived primary closure, 13 a split-skin graft, 16 a muscle flap, 41 a local or cross-leg fatseiocutaneous flap and 4 a free flap. Results The 82 patients gut a follow-up from 4 to 53 months （average, 17 months） . Of them, 78 had their injured limbs saved and 4 had to ulldergo seeondary amputation below the knee. On av- erage, those with successful limb salvage ulderwent VSD for 1.6 times and surgery for 3.7 times. Sixty-six fractures were primarily healed after an average time of 6.4 months. Seven patients were afflicted by delayed union, 5 by nouunimu 9 by wound infection and 3 by e.hronic osteomyelitis. Conclusion Gustilo Ⅲ B and Ⅲ C fractures in lhe lower limb eau be successfully salvaged by debridement, skeletal reconstruction, VSD and delayed flap reconstruction.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2012年第10期863-866,共4页
Chinese Journal of Orthopaedic Trauma
基金
上海市科学技术委员会科研汁划项目（11jc1409400）
关键词
下肢
骨折
开放性
引流术
外科皮瓣
Lower extremities
Fractures, open
Drainage
Surgical flaps
