临时性血管分流术在四肢GustiloⅢC型开放性骨折治疗中的临床应用研究  

Clinical study of temporary intravascular shunts in the treatment of Gustilo type ⅢC open fractures of the limbs

作　　者：杨福周[1] 罗锦辉[1] 黄远清[1] 

机构地区：[1]惠州市中心人民医院手足外科,广东516001

出　　处：《创伤外科杂志》2017年第2期120-123,共4页Journal of Traumatic Surgery

基　　金：惠州市科技计划项目(20140802)

摘　　要：目的探讨临时性血管分流术(TIVS)后行清创、骨折复位固定在GustiloⅢC型开放性骨折中的疗效。方法笔者选取60例GustiloⅢC型四肢开放性骨折患者,分为两组,各30例,均合并血管损伤。分别在术中采用传统方法和TIVS处理损伤血管,比较两组血运重建时间与伤肢伤口愈合时间、骨折愈合时间,肢体运动及感觉功能的恢复情况、截肢率、治疗周期及住院时间,医疗费用。结果观察组血运重建时间、伤口愈合时间、骨折愈合时间、平均住院费用分别为(134.2±14.8)h,(11.4±1.7)d,(3.06±0.36)个月,(10.2±1.3)d,(2.31±0.37)万元,均低于对照组,组间差异有统计学意义(P<0.05)。观察组FuglMeyer总评分、运动功能和感觉功能评分分别为(89.2±11.2)、(42.9±5.7)和(46.3±6.2),均高于对照组,组间差异有统计学意义(P<0.05);观察组截肢率低于对照组,组间差异有统计学意义(P<0.05)。结论TIVS在GustiloⅢC型开放性骨折患者的治疗中,可在最短时间内恢复肢体血运,减轻术后功能障碍,降低肢体截肢率和医疗负担。Objective To investigate the effect of temporary intravascular shunts（TIVS）,debridement and fracture reduction and fixation on Gustilo type ⅢC open fracture. Methods Sixty patients with Gustilo type ⅢC open fracture were divided into 2 groups,30 patients（ the control group） received traditional treatment and the other30 patients（ the treatment group） received TIVS to treat their injured vessels. The revascularization time,wound healing time,wound healing,recovery condition of motor and sensory function of the limb,amputation rate,treatment cycle,hospital stays,hospitalization costs were compared between the two groups. Results The time of revascularization,wound healing time,fracture healing time,the average length of hospitalization and the hospitalization cost of the treatment group were（134. 2 ± 14. 8） h,（11. 4 ± 1. 7） d,（3. 06 ± 0. 36） months,（10. 2 ± 1. 3） d,（2. 31 ± 0. 37）thousand yuan,which were,less than those of the control group,and the differences were statistically significant（ P〈0. 05）. The Fugl-Meyer score,motor function score and sensory function score of the treatment group were（89. 2 ±11. 2）,（42. 9 ± 5. 7） and（ 46. 3 ± 6. 2）,which were higher than those of the control group,and the differences were statistically significant（P〈0. 05）. The amputation rate of treatment group was 3. 3%,which was lower than that of the control group,and the difference was statistically significant（P〈0. 05）. Conclusion TIVS can recover the blood supply of limb within shorte time,alleviate the dysfunction after operation and decrease the amputation rate and hospitalization costs to patients who suffer Gustilo type ⅢC open fracture.

关 键 词：四肢骨折 开放性骨折 血管分流 临床疗效 

分 类 号：R683.4[医药卫生—骨科学]