显微外科技术结合Ilizarov技术治疗GustiloⅢC型胫腓骨开放性骨折的疗效分析  

Treatment of GustiloⅢC open tibiofibular fractures by microsurgery combined with Ilizarov technique

作　　者：李善庆 胡锐[1] 安颖 朱进 吴明正 严立[1] Li Shanqing;Hu Rui;An Ying;Zhu Jin;Wu Mingzheng;Yan Li(Department of Hand Surgery 2,Repair and Reconstruction,Wuhan NO.4 Hospital,Wuhan Puai Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430033,China)

机构地区：[1]武汉市第四医院,华中科技大学同济医学院附属武汉普爱医院手外二.修复重建科,430033

出　　处：《中华创伤骨科杂志》2021年第7期583-587,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨显微外科技术结合Ilizarov技术治疗GustiloⅢC型胫腓骨开放性骨折的疗效。方法回顾性研究自2014年1月至2016年12月华中科技大学同济医学院附属武汉普爱医院手外二.修复重建科收治的20例GustiloⅢC型胫腓骨开放性骨折患者资料。男13例,女7例;年龄36~56岁,平均42.6岁;受伤至手术时间为2~6 h,平均4.3 h;近端骨缺损6例,中段骨缺损9例,远端骨缺损5例;软组织缺损面积10 cm×6 cm~12 cm×9 cm,骨缺损长度平均为10.3 cm;一期采用显微外科技术修复血管、神经,重建血运,二期安装Ilizarov环形外固定支架,双向骨搬运修复骨与软组织缺损。术后记录骨搬移时间、创面愈合时间、骨搬运距离、外固定时间、外固定指数、延长区固化时间和并发症发生情况,按照Palay和Maar提出的标准评定疗效。结果所有患者术后获12~30个月(平均24个月)随访。骨缺损和软组织缺损得到良好的修复,均返回日常生活;骨搬运至骨折端对合时间为50~160 d(平均75.8 d),创面愈合时间为60~150 d(平均100.6 d),骨搬运距离为8~13 cm(平均10.3 cm);外固定时间为12~20个月(平均14.0个月),外固定指数为1.6个月/cm,延长区固化时间为5~16个月(平均10.9个月);未发生感染、成骨不良及再骨折,2例出现术后轴线偏移,3例发生踝关节僵硬;按照Palay和Maar提出的标准评定疗效:优5例,良12例,可3例。结论显微外科技术结合Ilizarov双向骨搬运技术可以有效治疗GustiloⅢC型开放性骨折,重建肢体血液循环,值得推广。Objective To explore the clinical efficacy of microsurgery combined with Ilizarov technique in the treatment of GustiloⅢC open tibiofibular fractures.Methods From January 2014 to December 2016,20 patients with GustiloⅢC open tibiofibular fracture were treated at Department of Hand Surgery 2,Repair and Reconstruction,Wuhan NO.4 Hospital,Wuhan Puai Hospital.They were 13 men and 7 women,aged from 36 to 56 years(average,42.6 years).The time from injury to operation ranged from 2 to 6 hours(average,4.3 hours).The defects were at the proximal bone in 6 cases,at the middle bone in 9 cases and at the distal bone in 5 cases.The area of soft tissue defect ranged from 10 cm×6 cm to 12 cm×9 cm,and the lengths of bone defects averaged 10.3 cm.Microsurgery was conducted at the first stage to repair blood vessels and nerves and to reconstruct blood circulation,and an Ilizarov circular external fixator was installed at the second stage to repair bone and soft tissue defects by two-way bone transport.Bone transport time,wound healing time,bone transport distance,external fixation time,external fixation index,solidification time for the extended area and complications were recorded after operation.The curative efficacy was evaluated by Palay evaluation.Results All patients were followed up for 12 to 30 months(average,24 months).After the bone and soft tissue defects were well repaired,all the patients returned to daily life.The time from bone transport to apposition of fracture ends ranged from 50 to 160 days,averaging 75.8 days;the wound healing time ranged from 60 to 150 days,averaging 100.6 days;the bone transport distance ranged from 8 to 13 cm,averaging 10.3 cm;the external fixation time ranged from 12 to 20 months,averaging 14.0 months;the external fixation index was 1.6 months/cm;the solidification time for the extended area ranged from 5 to 16 months,averaging 10.9 months.No infection,malunion or re-fracture was observed;postoperative axis deviation was observed in 2 cases and ankle stiffness in 3 cases.According to

关 键 词：显微外科手术 骨折 胫骨 腓骨 骨搬运 

分 类 号：R687.3[医药卫生—骨科学]