儿童小腿GustiloⅢ型骨折合并软组织缺损的治疗  

The curative strategy of Gustilo type Ⅲ fracture with soft tissue defect of leg in children

作　　者：潘振宇[1] 喻爱喜[1] 余国荣[1] 陶圣祥[1] 

机构地区：[1]武汉大学中南医院显微骨科,武汉430071

出　　处：《中华显微外科杂志》2011年第6期461-463,共3页Chinese Journal of Microsurgery

摘　　要：目的观察儿童小腿GustiloⅢ型骨折合并软组织缺损的治疗效果。方法15例儿童，软组织缺损面积5cm×6cm-8cm×12cm；缺损部位：小腿上段2例，中段8例，下段及足背4例，小腿下方至跟后1例。均一期使用外固定器固定骨折，VSD闭合创面，二期行皮瓣转位（移植）覆盖创面。其中，远端蒂隐神经营养血管皮瓣3例，远端蒂腓肠神经营养血管皮瓣3例，腓肠肌内侧头肌瓣1例，交腿皮瓣7例，股前外侧皮瓣游离移植1例。结果行远端蒂隐神经营养血管皮瓣在术后5d皮瓣远端坏死1例，行交腿隐神经营养血管皮瓣后治愈。行远端蒂腓肠神经营养血管皮瓣在皮瓣远端黑痂形成1例，经换药后自愈。14例骨折愈合。GustiloⅢC型骨折1例，行小腿内侧交腿皮瓣后并发骨髓炎，18个月后随访，断端骨质吸收形成骨缺损。随访8个月～2年，皮瓣质地、颜色均可，外形略臃肿。结论外固定器固定联合皮瓣转位可以有效治疗儿童小腿GustiloⅢ型骨折合并软组织缺损。Objective To observe the curative effect of Gustilo typeⅢ fracture with soft tissue defect of leg in children. Methods Of the 15 patients, the area of the soft tissue defect varied from 5 cm × 6 cm to 8 cm × 12 cm. With regard to the location of soft tissue defect, two were situated at the upper third of the leg, eight were middle part of the leg, four were lower portion of the leg and dorsum of foot, one was lower portion of the leg and heel. The fracture was fixed by external fixation device and raw surface was closed by negative pressure drainage in the first stage. The raw surface was eventually covered by the transposition of regional flap or cross leg flap in the second stage. Among them, three patients underwent transposition of saphenous neuro-veno-faseiocutaneous flap, three patients underwent sural neuro-veno-fasciocutaneous flap transposition, one case of medial head of gastrocnemius muscle flap and 7 cases of cross leg flap were performed, while only 1 patient underwent free lateral anterior thigh flap transposition. Results One patient who underwent transposition of saphenous neuro-veno-fasciocutaneous flap present with necrosis of the distal end of the flap 5 days after operation, which was then cured by cross leg saphenous neuro-veno-fascioeutaneous flap. Dark crust in distal end of flap occurred in 1 patient who underwent sural neuro-veno-fasciocuta- neous flap, which was cured by changing dressings. Bone fracture of 14 patients were all healed. One patient who was classified as Gustilo Ⅲ C underwent cross leg flap, but bone defect was produced 18 months later. Through 3 months to 2 years follow-up, the texture, colour and shape of flap is good. Conclusion With regard to Gustilo type Ⅲ fracture combined with soft tissue defect of leg in children, external fixation coupled with flap transposition can cure effectively.

关 键 词：小腿骨折 GustiloⅢ型 小腿皮瓣 移植 儿童 显微外科 

分 类 号：R726.8[医药卫生—儿科]