急诊显微外科技术治疗下肢严重创伤的10年回顾性研究  

Ten years retrospective study of using primary microsurgery technology to treat patients with severe lower extremities injury

作　　者：柴益民[1] 张长青[1] 曾炳芳[1] Chai Yimin;Zhang Changqing;Zeng Bingfang(Department of Orthopedic Surgery,Shanghai Jiao Tong University Affiliated Sixth People ＂s Hospital,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院骨科,上海200233

出　　处：《中华显微外科杂志》2018年第5期459-463,共5页Chinese Journal of Microsurgery

基　　金：国家自然科学基金（81572122）;上海申康医院发展中心项目（16CR1020A）

摘　　要：目的本研究旨在回顾研究近10年上海市第六人民医院救治的下肢严重创伤患者，以明确显微外科技术对于提高保肢率及功能预后效果的价值。方法回顾性研究2006年1月至2016年1月在本院救治的下肢严重创伤患者，记录患者的一般情况、开放性骨折分型以及入院MESS评分，根据是否行急诊显微重建手术分为急诊显微修复组（A组）和非急诊显微修复组（B组），每组再根据患者入院MESS评分分为：A1、B1组（MESS评分〈7分）；A2、B2组（MESS评分≥7分）。记录患者的重建方式、住院时间、手术次数、术后并发症以及随访中的肢体功能指标，疾病影响量表评分（SIP）以及总共治疗费用等，比较分析各组间的差异。结果本研究主要对象为Gustilo Ⅲ度开放性骨折行保肢手术的患者，共纳入548例患者，A组患者211例（38.5%），B组患者337例（61.5%）。A1组37例，A2组174例；B1组181例，B2组156例，A、B组二期截肢率和并发症发病率分别为2.8%、11.8%和4.0%、13.3%。远期随访方面，B组患者术后2年视觉模拟量表（VAS）评分（2.86分）高于A组（2.74分），但差异无统计学意义（P〉0.05），A2、B2组术后2年VAS评分均相应高于A1和B1组；两组SIP评分结果与VAS评分结果类似。结论急诊显微外科技术的应用在下肢严重创伤中的应用使得保肢成功率得到了显著的提升，并且改善了保肢患者的预后功能及日常生活能力。ObjectiveTo clarify the role of microsurgery in limb salvage procedure and its efficiency in longterm functional results through a retrospective review of patients who sustained severe injury of lower extremities and had been treated Shanghai 6th people＇s hospital, in recent 10 years.MethodsPatients who sustained severe injury of lower extremities and treated with microsurgical techniques in January, 2006 to January, 2016 were studied. Patients＇ general information, classification of open fracture, and MESS were noted. The enrolled patients were divided into two groups（group A： primary microsurgical reconstruction; group B： non-microsurgical reconstruction） according to whether primary microsurgical reconstruction was performed or not. Each group were also further divided into subgroup according to preoperative MESS（MESS〈7 and MESS≥7）. The reconstruction methods, hospitalization days, operation times, postoperative complications, as well as the SIP were then recorded for each groups. The differences of these data among each groups were analyzed and compared.ResultsThe main objection was patient with Gustilo grade Ⅲ open fracture, totally 548 patients were admitted, with 312 males and 236 females. The main age was 35.6 years old. The main etiology was road traffic accident （79.7%）. There were 211 patients （38.5%） in group A, and 337 patients （61.5%） in group B. In group A, there were 37 patients in subgroup one （MESS〈7）, and 174 patients in subgroup two（MESS ≥7）. The rate of delayed amputation was 2.8%, while the complication rate was 11.8%. In group B, there were 181 patients in subgroup one（MESS〈7）, and 156 patients in subgroup two （MESS≥7）. The rate of delayed amputation was 4.0%, while the complication rate was 13.3%. In long-term survey, the average VAS score of group B was higher than that of group A, but no significant difference was noted. The average VAS scores in 2 year postoperatively in the subgroups （MESS≥7） were higher than those in the

关 键 词：严重下肢创伤 保肢 MESS评分 显微外科技术 

分 类 号：R658.3[医药卫生—外科学]