二期游离腓骨移植加钢板内固定在GustiloⅢ型开放性股骨骨折并长段骨质缺损中的应用  

The application of treatment of typeⅢopen femur fracture and massive bone defect with free vascularized fibular graft and fixed with plates later

作　　者：孙煦化[1] 甘干达[1] 陶智刚[1] 

机构地区：[1]中国人民解放军第181中心医院创伤骨科、显微外科,广西桂林541101

出　　处：《实用手外科杂志》2014年第4期429-431,共3页Journal of Practical Hand Surgery

摘　　要：目的：探讨二期游离腓骨移植加钢板内固定在 GustiloⅢ型开放性股骨骨折并长段骨质缺损中的临床应用效果。方法对16例GustiloⅢ型开放性股骨骨折并长段骨质缺损患者，早期行彻底清创、外固定架固定骨折，创面分别给予负压封闭引流（vacuum sealing drainage, VSD）或用无菌敷料覆盖，定期伤口换药。术后根据肉芽组织生长情况分别行植皮、邻近皮瓣转移或游离皮瓣移植修复创面。待创面完全愈合，拆除外固定架，二期行游离腓骨移植加钢板内固定治疗。结果所有病例均获随访，随访时间9个月～2.5年，平均1.5年。移植腓骨全部成活，股骨骨折均骨性愈合，愈合时间4～9个月。患肢均恢复正常负重行走，随访期间无再骨折。腓骨供区伤口愈合良好，膝、踝关节功能不受限。无踝关节不稳定及外翻畸形发生。结论早期彻底清创、外固定架固定骨折，待创面完全愈合，拆除外固定架，行游离腓骨移植加钢板内固定是治疗GustiloⅢ型开放性股骨骨折并长段骨质缺损的一种有效方法。Objective To explore the practical effect of treatment of type Ⅲ open femur fracture and massive bone defect with free Vascularized fibular graft and fixed with plates later. Methods 16 cases of type Ⅲ open femur fracture and massive bone defect were treated by early thorough debridement. The bone was external fixation. The wound was closed with VSD or sterile dressing that regularly replace. According to the growth of the granulation tissue after operation, the wound was healed with skin graft, nearby flap or free flap. After the wound was completely healed, the external fixators was removed. The type Ⅲ open femur fracture and massive bone defect was treated with free Vascularized fibular graft and fixed with plates. Results All cases were reviewed. The follow-up was 9 to 28 months （ averaging 18 months）. All Fibular graft were completely survived and all femur fracture were completely healed, the healing time was 4 to 9 months. The limbs walking were normal, no one was re-fracture. The wounds of fibula donor were healed. No one has ankle instability and valgus deformity. Conclusion It＆#39;s a effective method to treat type Ⅲ open femur fracture and massive bone defect with free Vascularized fibular graft and fixed with plates later.

关 键 词：开放性骨折 股骨 骨质缺损 游离腓骨移植 

分 类 号：R683.42[医药卫生—骨科学]