摘要
目的探讨尺桡骨Ⅲ度开放性骨折的治疗方法、皮瓣修复与外固定器应用效果。方法1998年2月～2004年2月共收治尺桡骨Ⅲ度开放性骨折17例,其中尺桡骨干骨折12例,尺桡骨下段骨折5例,合并桡动脉与正中神经损伤3例、腕关节脱位1例,合并软组织缺损16例。11例行切开复位、有限内固定结合外固定器固定,6例行切开复位、外固定器固定。3例行邻近带蒂皮瓣修复,另13例行髂腹股沟轴型皮瓣、股前外侧皮瓣及肩胛旁皮瓣修复,其中延迟一期皮瓣修复5例。桡动脉吻合、正中神经探查修复3例,腕关节开放复位1例。结果随访6～24个月,平均15个月。骨折愈合时间10～20周,平均14周。术后皮瓣均存活,正中神经功能基本恢复。肘关节功能正常,腕关节功能正常15例,2例轻度受限为骨折累及关节者。5例有针眼感染经换药、清创及口服抗生素后愈合。结论单边外固定器固定并皮肤和软组织缺损的皮瓣修复,结合切开复位、有限内固定,在尺桡骨Ⅲ度开放性骨折治疗中有独特的价值和良好的效果。
Objective To explore the methods and the results of unilateral fixator and flap repair in treatment of type Ⅲ open fractures of ulna and radius.Methods From February 1998 to February 2004,17 patients with type Ⅲ open fractures of ulna and radius were treated with unilateral external fixator and flap repair.They were all comminuted fractures with 12 shaft fractures and 5 distal shaft fractures complicated with wrist dislocation (1 case) or radial artery and median nerve injury (3 cases).Sixteen were complicated with skin and soft tissue defects.Eleven cases were treated with open reduction,limited internal fixation and external fixator.Six cases were treated with open reducation and external fixator.Three cases with radial artery and median nerve injuries were anastomosed and repaired.The skin and soft tissue defects in 16 cases were reconstructed by neighboring pedicled flaps (3 cases),or by groin axis flap,para-scapular flap and scapular side flap (13 cases).Results The duration of follow-up was 6 to 24 months (average 15 months).Ten to 20 weeks (average 14 weeks)were needed for bone healing.The function of injured median nerve was recovered basically.The motion function of elbow in 17 cases and wrist in 15 cases were restored to normal.Two cases of wrist injury were a little limited.Five cases of superficial pin infection occurred,which were cured by debridement and administration of antibiotics.Conclusion The unilateral external fixator and flap repair for skin and soft tissue defect can play special roles in the treatment of type Ⅲ open fractures of ulnas and radius.
出处
《中国骨与关节损伤杂志》
2005年第3期160-162,共3页
Chinese Journal of Bone and Joint Injury
