摘要
目的探讨GustiloⅢB和GustiloⅢC型胫骨骨折骨固定及组织瓣修复的方法和时机的选择。方法GustiloⅢB和GustiloⅢIC型胫骨骨折患者136例，男102例，女34例；年龄14。68岁，平均34岁。损伤程度：GustiloⅢB型98例，GustiloⅢC型38例。骨固定修复方法选择：一期行外固定架固定113例，钢板内固定4例；二期行骨固定19例。软组织修复方法选择：一期行带血管蒂组织瓣转位修复创面67例；一期行吻合血管游离组织瓣修复7例；62例一期行VSD负压封闭一周至数周后，二期行游离植皮9例，胫后动脉肌间隙穿支皮瓣11例，腓动脉穿支皮瓣13例，腓肠肌肌（皮）瓣14例，交腿皮瓣15例。结果本组所有患者创面皆完全愈合。术后随访10-24个月，121例患者骨折愈合：12例患者因大段骨缺损，二期行骨移植术后正常愈合；3例患者因感染并发骨髓炎、窦道形成，经再次手术，骨折端延期愈合；骨折愈合时间为5-12个月，平均7个月。结论GustiloⅢB、ⅢC型胫骨骨折的一期或二期骨固定及组织瓣修复各有优缺点，如有条件争取一期骨固定及组织瓣修复为最好。
Objective To investigate the choice of methods and time on the treatment of Gustilo type 11I B and type m c open tibia fractures by bone fixation and tissue flap repairing. Methods The clinic data of 156 cases of Gustilo Ⅲ B and ⅢC open tibia fractures were retrospectively studied. There were 102 males and 34 females, with average age of 34 years（range 14 to 68 years）. Ninety-eight cases were classified as Gustilo type ⅢB and 38 cases were type Ⅲ C in degree. In all cases, one hundred and thirteen were treated with one- stage external fixation, ninteen cases were treated with secondary bone fixation. Sixty-seven cases of all wounds were repaired by one-stage vascular pedicle skin flap. Seven wounds were repaired by one-stage free flaps with vascular anastomosis. Sixty-two cases were secondary repaired by different flaps after defect tissue under VSD （vacuum-sealing-drainage） treatment by 1 to several weeks, which contains 9 free skin graft, eleven muscle flaps based on posterior tibial artery perforator, thirteen flaps based on fibial artery perforator, fourteen gastroc- nemius falps and 15 cross-leg flaps. Results Wound of all cases were healed wholly. Primary union oc- curred in 121 cases, twelve vases healed after bone grafting for segmental bone defect. Three cases with delayed union healed after reoperation for infection that caused osteomyelitis and sinus tract. The period of bone healing was form 5 to 12 months. Conclusion The treatment of Gustilo Ⅲ B and Ⅲ C open tibia fractures by one- stage or secondary bone fixation and tissue flap repairing get their advantages and disadvantages, but one-stage bone fixation and tissue flap repairing was better where appropriate.
出处
《中华显微外科杂志》
CSCD
北大核心
2012年第5期374-377,I0004,共5页
Chinese Journal of Microsurgery
