应用外固定支架急性短缩成角二期延长治疗小腿复合组织缺损  

Defects of crural composite tissues treated by acute angular shortening and delayed distraction histo-genesis with an external fixator

作　　者：康庆林[1] 徐佳[1] 贾亚超[1] 陈红浩[1] 陆联松[1] 柴益民[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,200233

出　　处：《中华创伤骨科杂志》2015年第10期845-849,共5页Chinese Journal of Orthopaedic Trauma

基　　金：基金项目：国家自然科学基金面上项目（81272000）

摘　　要：目的探讨采用外固定支架急性短缩成角二期延长治疗小腿复合组织缺损的疗效。方法回顾性分析2009年5月至2014年8月采用外固定支架急性短缩成角二期逐渐延长技术治疗6例小腿复合组织缺损患者资料，男5例，女1例；年龄23。65岁，平均38．8岁。骨折按Gustilo分型：ⅢA型2例，ⅢB型4例。其中4例为急诊首诊，2例为外院治疗后转入。在生命体征稳定的基础上，彻底清创，然后根据皮肤缺损的方位折弯，以求最大限度地关闭伤口。4例折弯后创面直接闭合，1例残留创面经换药后愈合，另1例自体皮片移植消除剩余创面。将预构的环形外固定支架安装在折弯的小腿上，待伤口完全愈合后2～3周开始矫正畸形，并通过牵张成组织技术重建组织缺损。结果6例患者创面均顺利愈合，不需实施额外的显微皮瓣或骨移植手术，折弯后重建的软组织区域愈合平整，质地和周围皮肤一致。随访时间为8～24个月，平均16．8个月。平均延长长度为8．0cm，外固定支架佩戴时间平均为17．3个月，骨延长指数为2．3个月／cm，根据Paley骨与功能分级评定肢体功能恢复结果：优2例，良4例。x线片示骨缺损区完全重建，骨愈合良好，下肢机械轴完全恢复。患肢行走负重功能完全恢复。结论采用急性短缩成角二期延长治疗小腿软组织与骨复合缺损不需借助显微皮瓣和骨移植技术，避免了供区并发症，是一种值得尝试的方法，适合急性与亚急性开放性损伤的快速处理。Objective To evaluate the efficacy of acute angular shortening and delayed distraction histogenesis with an external fixator in the treatment of crural composite tissue defects. Methods From May 2009 to August 2014, 6 patients with crural composite tissue defects were treated by acute angular shortening and delayed gradual distraction histiogenesis with an external fixator. They were 5 men and one woman, from 23 to 65 years of age （average, 38.8 years） . According to the Gustilo classification, 2 cases were graded as type ]IIA and 4 as type llI B. Four of them received primary treatment at our department while the other 2 were transferred to our hospital after primary management in other hospitals. Radical debridement was rapidly performed once life threatening factors were eliminated. The lower limbs were maximally bended to close the skin defects. The wounds were closed directly in 4 cases; the remnant wounds in the other 2 cases were cured by daily dressing in one and covered by skin graft in the other. Next, about 2 to 3 weeks after complete wound healing the pre-constructed circular fixators were mounted to the bended crus before they were adjusted to correct angulation deformity and reconstruct bone defects. Results All the wounds in the 6 cases healed successfully without additional microsurgical transfer of osteocutaneous flap. The regenerative skin tissue was similar to the skin in situ. The follow-ups ranged from 8 to 24 months （mean, 16. 8 months）. The average length of lengthened tibia was 8.0 cm and the time for Ilizarov external fixation ranged from 10 to 25 months （mean, 17.3 months）. The average bone lengthening index was 2.3 months/cm. The limb functional recovery was rated as excellent in 2 cases and good in 4. The radiography revealed complete reconstruction of bone defects and restoration of mechanical alignments in all the cases. No disability was recorded during fol- low-up. Conclusions Acute angular shortening and delayed distraction histogenesis with an external fixator is a ve

关 键 词：骨折 开放性 外固定器 骨延长术 ILIZAROV技术 

分 类 号：R687.3[医药卫生—骨科学]