骨搬移技术结合皮瓣转移技术治疗严重小腿毁损伤的疗效观察  

Clinical observation of bone transport technique combined with flap transfer technique in treatment of severe damaged calfinjury

作　　者：马金赛 马创[1] 袁继忠 轩春玲 多里昆·来海提 马赫迪尔 买买提明·赛依提[1] MA Jinsai;MA Chuang;YUAN Jizhong;XUAN Chunling;DUOLIKUN Laihaiti;MAHEDIER;Maimaitiming Saiyiti(The First Affiliated Hospital of Xinjiang Medical University,Xinjiang,Uruqmi,830054,China;The Branch of Changji,The First Affiliated Hospital of Xinjiang Medical University,Xinjiang,Changji,831100,China)

机构地区：[1]新疆医科大学第一附属医院,乌鲁木齐830054 [2]新疆医科大学第一附属医院昌吉分院,昌吉831100

出　　处：《新疆医学》2020年第1期18-22,27,共6页Xinjiang Medical Journal

基　　金：国家自然科学基金,(项目编号:81560350);国家自然科学基金,(项目编号:81760397)。

摘　　要：目的分阶段、分次实施治疗严重的小腿毁损伤,达到保留肢体和最大限度恢复下肢功能的目的。方法 2012年1月-2016年1月,使用清创、皮瓣转移、骨搬运、踝关节功能重建等方式治疗的8例小腿毁损伤的患者。男5例,女3例。年龄23~51岁,平均39.9±8.8岁。8例患者均为胫腓骨开放性骨折,其分型属于Gustilo Ⅲ型。其中3例为受伤当时急诊就诊本院。5例患者受伤后在基层医院就诊,出现并发症后转至我院就诊。结果随访时间26~38个月,平均32.6±4.7个月。患者入院后清创至感染控制所需14~21天,皮瓣转移术后需要21~35天观察,骨搬运用时50~120天,踝关节功能重建需要时间为90~120天。8例患者的小腿皮肤软组织缺损区域均得到了有效覆盖、胫骨骨缺损区域均得到了骨搬移的有效填充。8例患者骨搬运后均出现不同程度的足下垂症状、通过功能重建踝关节处于90°功能位,行走功能恢复。结论通过使用清创、皮瓣转移、骨搬运及踝关节功能重建等方法分阶段、分次治疗小腿毁损伤,可以有效纠正小腿皮肤软组织缺损、骨质缺损及纠正足下垂等症状。Objective In order to preserve limbs and restore the function of lower limbs to the maximum extent,the treatment of severe crus damage was carried out in different stages and different time.Methods From January 2012 to January 2016,8 patients with damaged calves were treated by debridement,flap transfer,bone transfer and functional reconstruction of ankle joint.There were 5 males and 3 females.The ages ranged from 23 to 51 years,with an average age of 39.9±8.8 years old.All 8 patients had open fractures of tibiofibula and were classified as Gustilo III.Among them,three cases were injured and received emergency treatment in our hospital.Five patients were treated in primary hospitals after injuries and transferred to our hospital after complications.Results The follow-up time was 26~38 months,with an average of 32.6±4.7 months.Debridement after admission and infection control required 14 to 21 days;observation after flap transfer needed 21 to 35 days;bone transfer needed 50 to 120 days;functional reconstruction of the ankle needed 90 to 120 days.The skin and soft tissue defect areas of the lower leg of eight patients were effectively covered,and the bone defect areas of the tibia bone were effectively filled.After bone transportation,all the 8 patients showed foot prolapse symptoms in different degree.The functional reconstruction of the ankle was in the functional position of 90°,and the walking function recovered.Conclusion Debridement,flap transfer,bone transfer and functional reconstruction of ankle joint can be used to treat the damaged calf in different stages and stages.

关 键 词：小腿毁损伤 皮瓣 骨搬运 足下垂 

分 类 号：R683.42[医药卫生—骨科学]