高能量创伤濒临截肢肢体的保肢手术  

Limb salvage surgery for high-energy injured extremity nearing amputation

作　　者：吴文[1] 梁志林 艾克白尔·吐逊 WU Wen;LIANG Zhilin;AIKEBAIER Tuxun(Department of Orthopaedics,the Third Affiliated Hospital of Southern Medical University,Guangzhou,Guangdong 510630,China;不详)

机构地区：[1]南方医科大学附属第三医院骨科,广州510630 [2]新疆喀什第一人民医院创伤骨科,844000

出　　处：《中国骨科临床与基础研究杂志》2020年第4期197-203,共7页Chinese Orthopaedic Journal of Clinical and Basic Research

基　　金：西藏自治区自然科学基金组团式医学援疆项目计划[XZ2019ZR-ZY65(Z)]。

摘　　要：目的总结10年高能量创伤濒临截肢肢体的保肢手术经验,探讨其显微修复治疗方法及预后。方法回顾性分析2010年5月—2020年1月35例高能量四肢严重损伤患者的临床资料。根据毁损肢体严重程度评分(MESS)标准:6分16例、7分19例。主要显微外科技术包括:一期清创、外固定联合二期创面修复重建复合组织损伤;自体或异体动脉移植修复四肢大血管;对侧腓骨肌皮复合组织瓣修复下肢伴骨缺损的复合组织损伤;桥式皮瓣修复重建下肢严重损伤肢体;3D-CT血管造影辅助进行皮瓣移植数字化设计等。结果平均随访时间1.2年(6~48个月)。35例患者中34例保肢成功,肢体功能较术前得到改善。末次随访时采用周之德四肢功能评定标准,优7例、良19例、差9例,优良率74%。术后1年1例患者因并发慢性骨髓炎而行延迟性截肢手术。结论采用显微外科修复技术对高能量濒临截肢肢体进行保肢治疗是较为理想的方法,可有效降低截肢率和致残率;MESS标准简单准确,可帮助术者针对濒临截肢肢体制定客观有效的治疗方案。Objective To summarize 10 years’experience of limb salvage surgery for high-energy injured extremity nearing amputation(HIENA),and to explore microsurgical repair procedures and the prognosis.Methods Clinical data of 35 patients with HIENA were enrolled from May 2010 to January 2020 were analyzed retrospectively.According to mangled extremity severity score(MESS)criteria,there was 6 points in 16 cases and 7 points in 19 cases.Major microsurgical repair techniques included one-stage debridement,external fixation combined with second-stage wound repair for reconstruction of composite tissue injuries,autografting or allografting of arteries for repair of large blood vessels of extremity,opposite fibula myocutaneous complex tissue flaps for treatment of complex tissue injuries with bone defects at lower extremities,bridge flaps to repair severe injuried lower extremities,digital design of flap transplantation assisted by 3 D-CT angiography and so on.Results All patients were followed up for the average of 1.2 years(6 to 48 months),and the extremities in 34 of35 patients survived with improved extremity functions.According to the functional grading criteria of extremity introduced by Zhou Zhide,there were excellent in 7 cases,good in 19 and poor in 9 cases,with the excellent and good rate of 74%at the latest follow-up.After one year,one patient performed delayed amputation surgery due to chronic osteomyelitis.Conclusions Microsurgical repair techniques are reasonable and feasible methods for limb salvage surgery of the potential amputated extremity resulting from high-energy trauma,which decreasing the rate of amputation and developing disability.Being simple and accurate,MESS is helpful for HIENA to formulate an objective and effective surgical program.

关 键 词：创伤和损伤 高能量 濒临截肢肢体 修复外科手术 皮肤移植 外固定 血管移植术 

分 类 号：R642[医药卫生—外科学] R658[医药卫生—临床医学]