游离腓骨复合组织瓣修复胫骨近端开放性骨折后骨与软组织缺损  

Transplantation of free fbula composite tissue flap to repair bone and soft tissue defect after open fracture of proximal tibial

作　　者：刘重 郭永明 焦健 滕云升 张朝 石宇 吴珂 Liu Zhong;Guo Yongming;Jjiao Jian;Teng Yunsheng;Zhang Zhao;Shi Yu;Wu Ke(Department of Traumatic Orthopaedic,Xi'an 521 Hospital(Institute of Hand Microsurgery of Shanxci Province),Xi'an 710065,China)

机构地区：[1]西安521医院创伤骨科(陕西手显微外科研究所),710065

出　　处：《中华显微外科杂志》2019年第6期544-547,共4页Chinese Journal of Microsurgery

基　　金：陕西省重点研发计划项目(2018SF-192)。

摘　　要：目的探讨游离腓骨复合组织瓣修复胫骨近端开放性骨折后骨与软组织缺损的临床应用及效果。方法自2012年6月至2018年6月,应用游离腓骨复合组织瓣修复胫骨近端开放性骨折后骨与软组织缺损11例,其中男10例,女1例,年龄32~56岁,平均36岁;车祸伤6例,压砸伤5例;新鲜创面3例,慢性感染创面8例。其中游离腓骨皮瓣7例,游离腓骨-跚长屈肌筋膜瓣4例。移植腓骨长7~18em,皮瓣或肌筋膜瓣切取面积4 emx8 em-8 cmx20 em。所有患者术后3.6、12个月观察骨折愈合情况,术后1年评估伤肢功能。结果本组11例组织瓣全部成活,创面一期愈合10例,二期愈合1例,愈合时间12~18d。11例均获得随访,随访时间平均18个月,骨愈合时间6-9个月,平均7个月。患肢应用Enneking评分22~27分,平均25分,供区无功能障碍。结论游离腓骨复合组织瓣移植可缩短患者治疗时间,移植骨力学强度好,是修复胫骨近端开放性骨折后骨与软组织缺损理想的治疗方法。Objective To explore the clinical application and ffect of free fibula composite tissue flap transplantation to repair bone and soft tissue defect after open fracture of proximal tibial.Methods From June,2012 to June,2018,free fibula composite tissue flap transplantations were applied to repair bone and soft tissue defect after open fracture of proximal tibial in 11 cases.Of the 11 cases,there were 10 males and 1 female(their ages ranged from 32 to 56,36 on average);Six cases were caused by traffic accident,and 5 by crash.There were 3 fresh wounds and 8 chronic and infective wounds.Free fibular flaps were used in 7 cases,and free fibular flexor hallucis myocutaneous flaps were used in 4 cases.The fibular length with transplantation was 7-18 cm.The area of flaps or muscle flaps was ranged from 4 cmx8 cm to 8 cmx20 cm.Bone fracture healing was observed at 3,6 and 12 months after operation.The function of injured extremity was evaluated in 1 year after surgical operation.Results All were successfully repaired,and composite tissue flaps survived.Of which,10 wounds healed by first intention,and 1 wound healed by secondary intention,with the healing time of 12-18 days.All 11 cases were followed-up.The mean followed-up time was 18 months.The bone healing time ranged from 6 to 9 months(7 months on average).The Enneking Score System was applied to evaluate the leg function.Of the 11 cases,the mean scores was 25(ranged from 22 to 27).The donor sites were not found malfunctional.Conclusion Transplantation of free fibula composite tissue flap can reduce the treatment time with good mechanical strength.It is an ideal method to repair bone and soft tissue defect after open fracture of proximal tibial.

关 键 词：腓骨复合组织瓣 胫骨骨折 开放性骨折 显微外科技术 

分 类 号：R68[医药卫生—骨科学]