双向骨搬运技术联合皮瓣成形治疗开放性胫骨骨折伴大段骨缺损的疗效  

Curative effect of bi-directional bone transfer technique combined with flap plasty in treatment of open tibial fracture with large bone defect

作　　者：陈勋[1] 张世辉 张文韬 喻姿瑞 宋涛[1] 王宇飞[1] CHEN Xun;ZHANG Shi-hui;ZHANG Wen-tao;YU Zi-rui;SONG Tao;WANG Yu-fei(Department of Bone Microrepair Surgery,Red Society Hospital Affiliated to Xi'an Jiaotong University,Xi'an Shaanxi 710054,China)

机构地区：[1]西安交通大学附属红会医院骨显微修复外科,陕西西安710054

出　　处：《局解手术学杂志》2021年第2期132-136,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：陕西省自然科学基金(2020JM-688)。

摘　　要：目的分析双向Ilizarov骨搬运技术联合皮瓣成形术治疗GustiloⅢB、C型开放性胫骨骨折、大段骨缺损合并软组织损伤的临床疗效。方法回顾性分析18例GustiloⅢB、C型开放性胫骨骨折、大段骨缺损合并软组织损伤患者的临床资料。所有患者均采用一期外固定架维持复位,二期远、近端双向Ilizarov骨搬运联合皮瓣成形术治疗。结果所有患者术后连续随访12~18个月,平均(15±2.6)个月。所有患肢骨缺损均得以重建,且骨性愈合,创面均闭合,患肢长度与健侧差值为0.5~2.5 cm,平均(1.4±0.5)cm。均在术后65~119 d内行二次手术皮瓣成形,平均(89.75±14.56)d,其中4例患者术后3个月出现软组织嵌顿,行二次手术清理嵌顿组织并皮瓣成形,二次手术后30 d内切口愈合。17例患者行二次手术后创面恢复良好,无明显神经血管损伤;1例患者出现腓总神经麻痹,于术后4个月恢复。所有患者骨重建完成时间为10~14个月,平均(12.3±1.4)个月。所有患者均未出现创面愈合延迟、皮肤坏死、针道感染现象。结论双向Ilizarov骨搬运技术联合皮瓣成形术治疗GustiloⅢB、C型开放性胫骨骨折、大段骨缺损合并软组织损伤安全有效,骨重建时间短。Objective To analyze the clinical effect of bi-directional Ilizarov technique combined with skin flap plasty in the treatment of Gustilo typeⅢB andⅢC open tibial fracture with large bone defect and soft tissue injury.Methods The clinical data of 18 patients of Gustilo typeⅢB andⅢC open tibial fractures with large bone defects and soft tissue injury were analyzed retrospectively.All patients received external fixation for maintenance of reduction at the first stage,and received distal and proximal bidirectional Ilizarov technique combined with flap plasty at the second stage.Results All patients were followed up for 12 to 18 months,with an average of(15±2.6)months.All the bone defects of the affected limb were reconstructed,and the bone healed and wound surfaces were closed.The difference between the length of the affected limb and the healthy side was 0.5 to 2.5 cm,with an average of(1.4±0.5)cm.All patients underwent secondary flap plasty within 65 to 119 days after surgery,with an average of(89.75±14.56)days.Of whom 4 patients developed soft tissue incarceration 3 months after surgery,and underwent secondary surgery to clean incarcerated tissues and shape the flap,and the incision healed within 30 days after the second surgery.The wounds of 17 patients recovered well after the second operation without obvious neurovascular damage.One patient developed common peroneal nerve palsy and recovered 4 months after operation.The completion time of bone reconstruction in all patients was 10 to 14 months,with an average of(12.3±1.4)months.There was no delayed healing,skin necrosis or needle tract infection in patients.Conclusion Bi-directional Ilizarov technique combined with skin flap plasty is a safe and effective method for the treatment of Gustilo typeⅢB andⅢC open tibial fractures with large bone defects and soft tissue injury,which can shorten the time of bone reconstruction.

关 键 词：胫骨骨折 骨缺损 软组织损伤 Ilizarov骨搬运 皮瓣成形 

分 类 号：R641[医药卫生—外科学]