短缩-延长技术在小腿严重创伤中的应用  

Application of shortening and lengthening technique in severe lower leg trauma

作　　者：李建峰 黄雷 范永辉 裴建锋 张克伟 段杰斌 梁康雄 李宏胤 姚红毅 赵艳兵 Li Jianfeng;Huang Lei;Fan Yonghui;Pei Jianfeng;Zhang Kewei;Duan Jiebin;Liang Kangxiong;Li Hongyin;Yao Hongyi;Zhao Yanbing(Taiyuan Great Wall Traumatology and Orthopedic and Hand Surgery Hospital,Taiyuan 030012,China)

机构地区：[1]太原长城骨伤手外科医院,030012 [2]北京积水潭医院创伤骨科,100035

出　　处：《骨科临床与研究杂志》2020年第1期21-26,共6页Journal Of Clinical Orthopedics And Research

摘　　要：目的探讨应用短缩-延长技术在小腿严重创伤保肢中的疗效。方法回顾性分析2007年7月至2017年2月期间太原长城骨伤手外科医院采用一期急性短缩,二期骨延长技术治疗的小腿严重创伤患者8例,均为高能量损伤男性患者,平均年龄37.2(20~51)岁。受伤部位:右小腿上段1例,中下段4例(右侧3例,左侧1例),小腿远端3例(右侧2例,左侧1例)。受伤至就诊时间平均6.1(3~10)h,热缺血时间平均8.5(5~13)h。彻底清创后,骨缺损部软组织缺损、骨外露,软组织缺损面积在8 cm×4 cm^20 cm×12 cm之间。胫腓骨均同时短缩,短缩再植后患肢较健侧肢体平均短缩9.8(7~10)cm。选择4.0骨圆针固定胫腓骨(4例)、4.0骨圆针加钢丝固定胫腓骨(1例)、腓骨钢板固定加单边外固定架固定胫骨(1例)、单边外固定架加4.0骨圆针固定胫骨(2例)。骨折固定后修复血管、肌腱和神经。再植术后平均2.6(1.5~8.0)个月行Orthofix重建外固定支架固定胫骨行截骨延长术,术后1周肢体开始延长。结果本组8例患者清创后一期短缩肢体至远、近折端相接触;其中有7例术前伤口为横断创面,经彻底清创短缩肢体后,神经、肌腱、血管均无张力直接吻合,创面一期闭合;1例术前软组织损伤范围大,清创后软组织缺损面积约20 cm×12 cm,且伤口长度与肢体纵轴相一致,短缩后伤口无法一期闭合,给予创面封闭负压引流。术后1周行邮票植皮,再植术后2周闭合创面,无伤口感染等并发症发生。8例患者肢体延长术后均获平均2.8(1.5~9.0)年随访。1例患者延长过程中近端3枚钉道口出现短期红肿、浆液性分泌物,经换药、口服抗生素治疗后愈合,伤口无感染。肢体延长后均与健侧等长,延长段骨矿化好。平均延长时间2.7(2.3~3.5)个月,肢体离断处骨折均愈合;愈合时间平均11.6(10~15)个月。重建外固定支架佩戴时间平均16.6(12~30)个月。外固定架指数2.3个月/cm。8例骨断端�Objective To investigate the efficacy of shortening and lengthening technique in lower leg salvage after leg trauma.Methods Eight patients with severe lower leg trauma treated by acute shortening surgery in stage 1 and bony lengthening technique in stage 2 were retrospectively analyzed in Taiyuan Great Wall Traumatology and Orthopedic and Hand Surgery Hospital from July 2007 to February 2017.All patients were male and injured by high energy.The average age of them is 37.2(20-51)years.Injury site:1 case of upper right lower leg,4 cases of middle and lower leg(3 cases on the right,1 case on the left),3 cases of distal lower leg(2 cases on the right,1 case on the left).The average time from injury to treatment was 6.1(3-10)h.The average time of warm ischemia was 8.5(5-13)h.The soft tissue defect and bone exposure were found in the bone defect area after thorough debridement.The area of soft tissue defect was between 8 cm×4 cm and 20 cm×12 cm.The average shortening length of the affected limb was 9.8(7-10)cm compared with that of the healthy leg both tibia and fibula.Tibia and fibula were fixed with 4.0 round bone pin(4 cases),tibia and fibula were fixed with 4.0 round bone pin plus steel wire(1 case),tibia was fixed with fibula steel plate plus unilateral external fixator(1 case),tibia was fixed with unilateral external fixator plus 4.0 round bone pin(2 cases).The blood vessels,tendons and sutra were repaired after fracture fixation.The Orthofix reconstruction external fixator were used for tibia.The tibia was conducted for osteotomy and bone lengthening at a mean time of 2.6 months(1.5-8.0 months)after bone replantation.The limb began to lengthen one week after the operation.Results Eight patients’lower legs were contracted between the far and near ends after debridement in stage one.Seven patients’lower legs of transverse wound were closed in stage one,and the nerves,tendons and blood vessels were anastomosed directly without tension after debridement.The injury area in one patient with large soft tissue inj

关 键 词：骨重建 外固定器 小腿骨骼 热缺血 支架 创伤 

分 类 号：R68[医药卫生—骨科学]