外固定架联合皮瓣转位治疗合并软组织缺损的Pilon骨折  

Treatment of Pilon fracture combining soft tissus defect with external combined with flap transposition

作　　者：祝少博[1,2] 喻爱喜[1,2] 余国荣[1,2] 邓凯[1,2] 曾中华[1,2] 陶圣祥[1,2] 潘振宇[1,2] 

机构地区：[1]武汉大学中南医院显微骨科 [2]武汉大学医学院显微外科研究所

出　　处：《中华显微外科杂志》2006年第6期422-425,I0002,共5页Chinese Journal of Microsurgery

摘　　要：目的评估外固定架联合皮瓣移位术治疗合并有软组织缺损的Pilon骨折的临床疗效。方法首先使用外固定架联合有限内固定使骨折复位并固定之,然后根据患肢合并软组织缺损的情况,分别选用隐神经营养血管远端蒂皮瓣、腓肠神经营养血管远端蒂皮瓣及交腿皮瓣一期或二期修复其软组织缺损,软组织缺损大小4cm×6cm～7cm×17cm,皮瓣大小5cm×7cm～8cm×8cm。结果17例骨折复位及固定良好,无1例发生骨髓炎及骨外露,已有局部感染者炎症得到很好的控制；16例皮瓣全部成活,1例隐神经营养血管远端蒂皮瓣逆行转位患者皮瓣远端部分坏死,经换药后二期植皮,创口愈合；17例术后4～6个月后骨折愈合。结论外固定架联合皮瓣移位是治疗合并有软组织缺损Pilon骨折的一种较好的方法。Objective To evaluate effect of external fixation combined with flap transposition in Pilon fracture combining soft tissue defect through retrospective analysis, nehtotls Firstly, to rebuild ankle-joint in 17 Pilon fracture patients with external fixation combining limited internal fixation such as Kirschner wire, steel plete and tensile force screw. Then, to repair soft tissue defect of these with selecting reversed saphenous neurocutaneous island flap, reversed sural neurocutaneous island flap or cross leg flap. Areas of these defect were 4 cm x 6 cm-7 cm x 17 cm, and sizes of these flaps were 5 cm × 7 cm-8 cm× 18 cm. Results No soft tissue defect and ostemyelitis in 17 patients, to control local infection and obtain bone and tissue healing postoperation 4-6 months in these. There was flap necrosis in distal part of reversed saphenous neurocutaneous island flap 1 patient, to gain healing after change dressing and skingrafting. Conclusion External fixation combining with flap transposition is a better approach to treatment of Pilon fracture combining soft tissue defect.

关 键 词：PILON骨折 神经营养皮瓣 外固定架 

分 类 号：R687.3[医药卫生—骨科学]