负压封闭引流技术联合游离皮瓣移植治疗合并骨折的小腿及足踝部热压伤  

Vacuum sealing drainage combined with transferred free tissue flap for treatment of massive heat-press injury complicated with fracture in the cruris

作　　者：严立[1] 胡锐[1] 丁凡[1] 程文俊[1] 周蓓[1] 郑琼[1] 勘武生[1] 任义军[1] 

机构地区：[1]华中科技大学同济医学院附属武汉普爱医院骨科,武汉430033

出　　处：《中华创伤骨科杂志》2013年第4期312-315,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨负压封闭引流（VSD）技术联合游离组织瓣移植治疗合并骨折的小腿及足踝部大面积热压伤的疗效。方法2004年2月至2011年12月共收治13例合并骨折的小腿及足踝部大面积热压伤伴软组织缺损患者，男10例，女3例；年龄23～55岁，平均36岁。骨折按AO分型：A1型2例，A2型1例；B1型1例，B2型4例，B3型1例；C1型3例，C2型1例。创伤部位：小腿中下段7例，内踝部2例，外踝并足背部4例。创面缺损面积为18cm×8-35cm×22cm。平均25cm×16cm。早期清创，创面行VSD技术治疗并置管、持续抗生素盐水冲洗，待创面清洁后予骨折内固定或动力装置重建，同时应用游离组织瓣移植覆盖创面。末次随访时按Johner-Wruhs的方法对功能进行评定。结果 所有皮瓣均一期愈合、无感染发生。所有患者术后获16-90年月（平均48个月）随访，内固定及骨与肌腱的外露区域得以游离皮瓣良好覆盖，骨折均完全愈合，愈合时间为6-12个月（平均7.2个月），无骨不连发生。7例患者因肌腱缺损行阔筋移植重建，3例患者因肌腱粘连行肌腱松解术。4例患者重建肌腱肌力Ⅴ级、2例Ⅳ级、1例患者踝关节保持功能位肌腱粘连，未予松解。末次随访时按Johner-Wruhs的方法评定功能：优7例，良4例，可2例。结论 VSD技术联合游离组织瓣移植能够早期修复合并骨折的小腿及足踝部大面积热压伤，有利于骨折的早期愈合及肢体功能恢复。Objective To explore the treatment effects of vacuum sealing drainage （VSD） combined with transeferred free tissue flap for massive heat-press iniury complicated with fracture in the cruris.Methods From February 2004 to December 2011, 13 patients with massive heat-press injury complicated with fracture in the cruris were treated in our department. They were 10 men and 3 women, aged from 23 to 55 years （average, 36 years） . By AO classification, there were 2 cases of type A1, one case of type A2, one type B1 4 type B2, one type B3, 3 type C1 and one type C2. Seven cases had injury at the middle or lower part of the cruris, 2 at the medial malleolus and 4 at the lateral malleolus or dorsal foot. The traumatic areas ranged from 18cm× 8 cm to 3.5 cm× 22 cm （average, 25 cm×16 cm） .After debridement, VSD was applied, followed by continuing douching with physiological saline plus antibiotics. After the wounds were clean,the fractures were fixated using internal fixation and the defective dynamic devices were reconstructed before a free tissue f]ap was transferred to cover the wounds. The functional recovery was assessed at the last follow-ups using the Johner-Wruhs system. Results All theflaps survived at the primary stage. No inffections were noted. The patients were followed up for 16 to 90 months （average, 48 months）. The fractures healed completely with fine coverage of the wounds in a period of 6 to 12 months（average,7.2months）.No monunion occurred.The myodymamia of reconstructed tendon was grade Ⅴ in 4 cases and grade Ⅳ in 2 cases.One patient still had funtional tendon adhesion.According to Johner-Wruhs system,7 cases were rated as excellent,4 as good and 2 as fair.Conclusion In the treatment of massive heat-press injury complicated with fracture in the cruris,VSD combined with transferred free tissue flap can not only repair soft tissue defects but also facilitate fracture healing and functional rehabilitation of the lower extremity.

关 键 词：下肢 软组织损伤 骨折 外科皮瓣 引流术 

分 类 号：R658.3[医药卫生—外科学]