带监测皮岛游离腓骨复合组织瓣移植修复胫骨中上段Gustilo Ⅲ B和Ⅲ C型骨折  

Treatment using free fibular complex tissue valve graft with monitoring skin flap in the early repair of Gustilo Ⅲ B or Ⅲ C fractures on the mid-upper sections of tibia

作　　者：陈福生 王健[2] 李军 王茂荣 

机构地区：[1]温州手足外科医院,325000 [2]温州医学院附属第一医院骨科

出　　处：《中华移植杂志（电子版）》2012年第2期23-26,共4页Chinese Journal of Transplantation(Electronic Edition)

摘　　要：目的探讨小腿高能量损伤后应用移植带监测皮岛游离腓骨复合组织瓣早期修复胫骨中上段GustiloⅢB型和ⅢC型骨折的临床疗效。方法总结温州手足外科医院2004年12月至2010年6月采用带监测皮岛游离腓骨复合组织瓣联合外固定支架早期治疗胫骨中上段GustiloⅢB型和ⅢC开放性骨折10例,胫骨缺损长度4.1～6.5cm,软组织缺损面积3.2cm×5.2cm～5.1cm×8.3cm,单纯胫前血管损伤伴缺损4例,胫前与胫后血管同时损伤2例。损伤后行游离腓骨复合组织瓣移植中位时间8(7～11)d,复合组织瓣与受区血管直接吻合4例,腓动静脉桥接胫前动静脉6例。结果 10例中位随访时间15(12～24)个月,创面Ⅰ期愈合7例,Ⅱ期愈合2例;伤口不愈合并有死骨形成,经死骨摘除清创后愈合1例。中位住院时间29(25～42)d,X线摄片示术后18(12～24)周移植腓骨与胫骨骨愈合,患肢开始部分负重时间为术后12～24周,完全负重时间为48～72周。Enneking系统肢体功能评定结果:优4例、良3例、可2例、差1例。结论小腿高能量损伤后应用带监测皮岛的游离腓骨复合组织瓣早期修复胫骨中上段GustiloⅢB与ⅢC型骨折骨缺损可Ⅰ期完成带血运的骨移植及修复皮肤和软组织缺损,减少手术次数,早期封闭创面,促进骨折愈合,减少胫骨骨髓炎发生,有助于尽早恢复患者下肢功能。Objective To investigate the clinical efficacy of free fibular osteocutaneous flap with a skin island in the early repair （stage Ⅰ） of Gustilo ⅢB and ⅢC fractures and bone defects of the mid-upper tibia after high-energy injury to the calf. Methods Ten patients with open Gustilo ⅢB and ⅢC fibular fractures complicated by bone and soft-tissue defects who were treated with free fibular osteocutaneous flap with a skin island and an external fixator in Wenzhou Hospital of Hand and Foot Surgery from December 2004 to June 2010 were reported. In all patients, the length of tibial defects ranged from 4. 1 to 6. 5 cm and the area of soft-tissue defects ranged from 3.2 cm ×5.2 cm to 5.1 cm ×8.3 cm. The average time from injury to free fibular osteocutaneous flap transplantation was 8 d. Four cases experienced the direct anastomosis of the complex tissue valve and vessels in recipient area and 6 cases experienced fibular arteriovenous fistula bridging with tibial anterior arteriovenous fistula. Results The patients were followed up for 15 （12 -24） months. Seven cases had wound surface healed at Stage Ⅰ, while 2 cases experienced Phase Ⅱ healing because of the distal flap necrosis caused by the venous return disorders. One case appeared early postoperative subepithelial hematoma and the unhealed wound was associated with the formation of sequestrum, which healed after the sequestrum was removed with debridement. Hospitalization time was 29 （25 -42 ） d. The X-ray showed that the transplanted fibular and tibial bone healed in 18 （ 12 -24） weeks after surgery. Partial weight-bearing on the affected limb began in 12 -24 weeks and complete weight-bearing began in 48-72 weeks after surgery. The results of Enneking system assessments for limb function were excellent in 4 cases, good in 3 cases, fair in 2 cases, and poor in 1 case. Conclusion The application of free fibula complex tissue valve graft with monitoring skin flap can achieve one-stage bone transplantation with blood circulation, fix the de

关 键 词：胫骨骨折 骨缺损 组织移植 修复 外科皮瓣 腓骨瓣 

分 类 号：R658.3[医药卫生—外科学]