小腿开放性骨折中软组织缺损的一期修复  

One-stage repair of soft tissue defects in open leg fracture

作　　者：关德宏[1] 王冬艳[1] 贾涛[1] 陈天新[1] 赵东波[1] 乔久涛[1] Guan Dehong;Wang Dongyan;Jia Tao;Chen Tianxin;Zhao Dongbo;Qiao Jiutao(Department of Orthopaedics, The Second Affiliated Hospital to Harbin Medical University, Harbin 150086, China)

机构地区：[1]哈尔滨医科大学附属第二医院骨外科,150086

出　　处：《中华创伤骨科杂志》2019年第10期859-863,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨小腿开放性骨折中软组织缺损一期行骨折固定联合皮瓣修复的临床疗效。方法回顾性分析2011年1月至2018年1月哈尔滨医科大学附属第二医院骨外科收治的34例小腿开放性骨折伴软组织缺损患者资料。患者男31例,女3例;年龄13~54岁,平均35岁。根据Gustilo分型:ⅢA型31例,ⅢB型3例;软组织缺损6 cm×3 cm^25 cm×10 cm,所有患者急诊一期做骨折固定同时行皮瓣修复。32例行接骨板内固定,2例行单臂外固定支架固定;34例均用游离股前外侧皮瓣修复。术后观察皮瓣存活情况,有无血管危象发生和骨感染发生。结果本组34例游离皮瓣全部成活,无血管危象发生。所有患者均获随访,时间6个月至3年(平均10个月)。皮瓣愈合良好,质地柔软,外形满意。缺损部位无骨感染发生。所有患者经过术后康复膝关节伸直160°~180°,屈曲90°~110°;踝关节背伸90°~110°,跖屈100°~120°。结论小腿开放性骨折伴软组织缺损经彻底清创,一期行骨折内固定同时行皮瓣修复软组织缺损,创口一期愈合,避免了感染的发生,皮瓣成活良好。Objective To evaluate one-stage repair of leg open fracture with soft tissue defect by fixation plus skin flap. Methods From January 2011 to January 2018, 34 patients with leg open fracture plus soft tissue defect were treated at Department of Orthopedics, The Second Affiliated Hospital to Harbin Medical University. They were 31 males and 3 females, aged from 13 to 54 years(average, 35 years). According to the Gustilo classification, the defects were type ⅢA in 31 cases and type ⅢB in 3 cases. The wound size ranged from 6 cm×3 cm to 25 cm×10 cm. All patients were treated with emergency fracture fixation and flap repair by one stage after thorough debridement. Internal bone plating was performed in 32 patients and external fixation at a single arm in 2 patients. All defects were repaired with a free anterolateral thigh flap. Flap survival, vascular crisis and bone infection were followed up postoperatively. Results All the free flaps survived in the 34 cases with no vascular crisis. These patients were followed up for 6 months to 3 years (average, 10 years). The flaps healed well, with good appearance and soft texture. No bone infection occurred at the defective sites. After postoperative rehabilitation, the knee extension ranged from 160° to 180°, knee flexion from 90° to 110°, ankle dorsal extension from 90° to 110°, and ankle plantar flexion from 100° to 120°. Conclusion Soft tissue defects in leg open fracture can be effectively treated by flap repair after thorough debridement at the same time of fracture fixation, because the primary wound healing can avoid infection and lead to fine survival of the flap.

关 键 词：骨折 开放性 软组织损伤 外科皮瓣 修复外科手术 小腿 

分 类 号：R687[医药卫生—骨科学]