一期封闭式负压引流联合双蒂滑行皮瓣治疗开放性胫腓骨骨折伴胫前软组织缺损  

APPLICATION OF ONE STAGE VACUUM SEALING DRAINAGE COMBINED WITH BI-PEDICLE SLIDING FLAP TRANSPLANTATION FOR OPEN TIBIOFIBULAR FRACTURE AND SOFT TISSUE DEFECTS OF THE LOWER LEG

作　　者：叶国强[1] 傅国[2] 戚剑[2] 

机构地区：[1]广州中医药大学附属骨伤科医院显微创伤骨科,广州510240 [2]中山大学附属第一医院显微创伤手外科

出　　处：《中国修复重建外科杂志》2015年第8期955-958,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨一期封闭式负压引流(vacuum sealing drainage,VSD)联合双蒂滑行皮瓣治疗开放性胫腓骨骨折伴胫前软组织缺损临床效果。方法 2012年1月-2014年7月,收治开放性胫腓骨骨折25例。男18例,女7例;年龄12~65岁,平均35.2岁。损伤类型:交通事故伤20例,高处坠落伤3例,重物砸伤2例。左侧14例,右侧8例,双侧3例。Gustilo分型:Ⅱ型6侧,Ⅲa型19侧,Ⅲb型3侧。胫前软组织缺损范围6 cm×3 cm^12 cm×5 cm。受伤至入院时间1~18 h,平均4.5 h。彻底清创后先行胫骨骨折微创内固定,然后设计胫前外侧双蒂滑行皮瓣修复胫前创面,皮瓣范围24 cm×6 cm^48 cm×8 cm,皮瓣前移后在外侧减张口内显露腓骨,并于骨膜下用重建钢板固定腓骨骨折,最后VSD材料覆盖对合口及减张口。术后给予抗生素生理盐水持续灌洗,15 d后去除VSD材料,皮肤缺损区游离植皮修复。结果术后15 d去除VSD材料时,18侧肢体对合口完全愈合;9侧对合口处遗留创面,行植皮修复;1侧创面存在细菌生长,对症处理后愈合。术后对合口及减张口植皮均愈合,皮瓣均顺利成活。患者均获随访,随访时间6~24个月,平均18个月。X线片复查示,骨折均愈合,愈合时间2.5~5个月,平均3.2个月。结论一期应用VSD联合双蒂滑行皮瓣治疗GustiloⅡ~Ⅲa型开放性胫腓骨骨折,手术操作相对简便安全,住院周期短,并发症少,费用低,且疗效肯定。Objective To study the function and effectiveness of self-manufacture osteotomy guide device in osteotomy. Methods A guide device was manufactured, which could guide the drill and osteotome. Sixty femoral moulds which cover with bubble were used as human femurs, and a 3 cm long, 1 cm wide crack was made in the femoral moulds supracondylar to imitate operation incision. The femoral moulds were divided into 3 groups（n=20）： non-guiding group（group A）, simple drill guiding group（group B）, and drill-osteotome guiding group（group C）. The osteotomy time, the variation range of the drill holes（incision side and the contralateral side）, the variation range of the osteotome incisions（incision side and the contralateral side）, and the match rate of drill holes and osteotome incision were recorded. And between February 2013 and January 2014, the osteotomy guide device was used to guide proximal tibia osteotomy in 6 patients with tibia infected nonunion to excise of infected bones. Results The osteotomy time of groups B and C was significantly less than that of group A, and it was significantly less in group C than group B（P0.01）. The match rate of drill holes and osteotome incision in groups B and C was significantly higher than that of group A, and group C was significantly higher than group B（P0.05）. The variation range of the drill holes in both incision side and contralateral side of groups B and C was 0, which was significantly less than that of group A（P0.01）. The variation range of the osteotome incisions in both incision side and contralateral side of groups B and C was significantly less than that of group A, group C was significantly less than group B（P0.01）. Preliminary clinical results showed that the osteotomy guide device was simple to use, and precise in guidance for drill and osteotome, so it could reduce the time for repeated targeting during drilling and osteoming. The osteotomy time was 8.3-11.2 minutes（mean, 9.5 minutes）. The surface of osteotomy was smooth an

关 键 词：封闭式负压引流 双蒂滑行皮瓣 开放性骨折 胫腓骨骨折 软组织缺损 

分 类 号：R687.3[医药卫生—骨科学]