游离皮瓣结合Ilizarov骨搬运技术治疗GustiloⅢB型胫骨干感染性骨与软组织缺损  

Treatment of infectious bone and soft tissue defects following tibial shaft fracture of Gustilo type Ⅲ B using free flap and Ilizarov bone transport

作　　者：严立 凃松 易新成[2] 胡锐[2] 韩琼[2] 任义军[2] 彭昊[1] 

机构地区：[1]武汉大学人民医院骨科,武汉430063 [2]华中科技大学同济医学院附属普爱医院手外科Ⅱ-修复重建科,武汉430033

出　　处：《中华创伤骨科杂志》2016年第12期1033-1039,共7页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨游离皮瓣移植结合Ilizarov骨搬运技术治疗GustiloⅢB型胫骨干感染性骨与软组织缺损的临床疗效。方法对2010年5月至2015年2月收治的19例GustilomB型胫骨干感染性骨与软组织缺损患者资料进行回顾性分析，男15例，女4例；年龄21～58岁，平均45．3岁；病程16～21个月，平均17．9个月。感染创面面积10cm×6cm～21cm×12cm；骨缺损长度5～11cm，平均7．4cm。采取早期清创、简单外固定支架重建骨性支架、游离皮瓣覆盖创面及抗生素骨水泥念珠填塞死腔，待感染控制后再行Ilizarov骨搬运技术及植骨来重建胫骨及患肢功能。结果皮瓣全部成活，其中有1例皮瓣远端皮缘坏死，换药后痊愈。4例患者发生钉道感染，给予钉道换药及抗生素治疗后感染得以控制；骨段滑移端及骨牵张端均在骨搬运静止后1个月行植入自体髂骨松质骨，所有患者骨愈合均为直接愈合。所有患者获19～36个月（平均25个月）随访，未见二次骨折及成角畸形发生，总治疗时间平均为17．9个月，无一例感染复发。末次随访时按Puno评分对功能进行评定：优7例，良6例，可6例。结论游离皮瓣移植结合Ilizarov骨搬运技术治疗GustiloⅢB型胫骨干感染性骨与软组织缺损，临床疗效肯定。Objective To report treatment of infectious bone and soft tissue defects caused by tibial shaft fracture of Gustilo type III B using free flap and Ilizarov bone transport. Methods Nineteen patients who had suffered from infectious bone and soft tissue defects following tibial shaft fracture of Gustilo type HI B were treated from May 2010 to February 2015. They were 15 men and 4 women, aged from 21 to 58 years （average, 45.3 years）. Their course of disease ranged from 16 to 21 months, averaging 17.9 months. The area of their infectious defects ranged from 10 cm × 6 cm to 21 cm × 12 cm, and the length of their bone defects from 5 to 11 em （average, 7.4 cm）. They were treated with debridement, simple external fixation to reconstruct bony support, coverage of wounds with free flap, and stuffing the dead space with antibiotic con- crete beads, followed by Ilizarov bone transport and bone graft after control of infection to reconstruct the defective tibia and function of the affected limb. Results All the flaps survived. Necrosis occurred at the distal margin of one flap but responded to dressing. Pin tract infection occurred in 4 cases but also responded to dressing and antibiotic therapy. Autografts of iliae cancellous bone were implanted into the gliding and traction ends of the bone fragments one month after bone transport had come to rest. All the patients achieved direct bony union. The patients were followed up for an average of 25 months（range, from 19 to 36 months）.No secondary fractures or angular deformity was observed. The total treatment time averaged 17.9 months, with no recurrence of infection. According to the Puno score system for functional evaluation at the last follow-up, 7 cases were rated as excellent, 6 as good and 6 as fair. Conclusion The infectious bone and soft tissue defects caused by tibial shaft fracture of Gustilo type m B can be treated by free flap and Ilizarov bone transport, resulting in definitely positive outcomes.

关 键 词：胫骨 骨折 损伤 骨搬运 

分 类 号：R687.3[医药卫生—骨科学]