摘要
目的探讨利用游离皮瓣移植修复GustiloⅢB、ⅢC型胫腓骨骨折伴软组织缺损的临床疗效。方法采用回顾性病例系列研究分析2013年6月-2017年1月无锡市第九人民医院收治的46例胫腓骨GustiloⅢB、ⅢC型骨折伴软组织缺损患者临床资料,其中男34例,女12例;年龄1-67岁,平均39岁。创面缺损面积6 cm×20 cm-7 am×38 cm。Gustilo骨折分型ⅢB型31例,Ⅲc型15例。AO骨折类型:A型5例,B型23例,c型18例。均采用游离皮瓣移植修复:股前外侧皮瓣修复40例,背阔肌皮瓣修复6例。皮瓣面积:股前外侧皮瓣为6 cm×13 cm-14 cm×32 cm,背阔肌皮瓣为6 cm×22 cm-7 cm×40 cm。采用皮瓣成活率、并发症、骨折愈合时间、下肢功能评分系统(LEFS)及皮瓣功能7项检查等指标评价疗效。结果46例全部保肢成功。皮瓣完全坏死1例,皮瓣术后出现危象8例,积极探查处理后远端部分坏死3例,皮瓣完全成活率为91%。2例供区发生感染,并发症发生率为4%。患者均获随访7-42个月,平均19个月。骨折愈合时间平均43.5周。LEFS评分平均54分。按皮瓣功能7项检查指标评定:优11例,良29例,可4例,差2例,优良率为87%。结论游离皮瓣移植修复GustiloⅢB、ⅢC型胫腓骨骨折患者疗效满意,保肢成功率高,后期功能较好。
Objective To investigate the clinical efficacy of free flap transplantation in repairing the Gustilo typeⅢB andⅢC fractures of tibia and fibula combined with soft tissue defects.Methods A retrospective case series study was conducted on the clinical data of 46 patients who had Gustilo typeⅢB andⅢC fractures of tibia and fibula with soft tissue defects admitted from June 2013 to January 2017.There were 34 males and 12 females,aged 1-67 years(mean,39 years).The wound defect areas ranged from 6 cm×20 cm to 7 cm×38 cm.According to the Gustilo fracture classification,there were 31 cases of typeⅢB and 15 cases of typeⅢC.According to the AO fracture typing,there were five cases of type A,23 type B,and 18 type C.All patients were repaired with free flap transplantation,among which 40 patients were treated with anterolateral thigh flap and six with latissimus dorsi flap.The areas of anterolateral thigh flap ranged from 6 cm×13 cm to 14 cm×32 cm,and those of the latissimus dorsi flap from 6 cm x 22 cm to 7 cm×40 cm.Efficacy was evaluated by flap survival rate,complications,fracture healing time,lower limb function scoring system(LEFS),and skin flap function.Results All limbs were salvaged successfully.One case of total flap necrosis and eight cases of postoperative crisis occurred.After active exploration and treatment,three cases were seen distal local necrosis,and the total survival rate was 91%.Infection at the donor site was found in two cases.The complication incidence rate was 4%.All patients were followed up for 7-42 months,with an average of 19 months.The fracture healing time averaged 43.5 weeks,and the LEFS score averaged 54 points.According to the seven indexes of flap function,the results were excellent in 11 cases,good in 29 cases,fair in four cases,and poor in two cases,with an excellent and good rate of 87%.Conclusion Free flap transplantation can achieve satisfactory efficacy in treating Gustilo typeⅢB andⅢC of tibia and fibula combined with soft tissue defects,with high limb salvage rate and good function recovery.
作者
芮永军
吴永伟
刘军
马运宏
黎逢峰
陆尧
杨通
周明
康永强
顾珺
Rui Yongjun;Wu Yongwei;Liu Jun;Ma Yuahong;Li Fengofeng;Lu Yao;Yang Tong;Zhou Ming;Kang Yongqiang;Gu Jun(Department of Trauma Orthopedics,9th People's Hospital of Wuxi,Wuxi 214062,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2018年第10期881-885,共5页
Chinese Journal of Trauma
基金
江苏省卫生计生委面上项目(H2017077)
关键词
腿损伤
骨折
开放性
外科皮瓣
Leg injuries
Fractures
open
Surgical flap
