Gustilo Ⅲ C型下肢毁损伤的保肢治疗策略  

Limb-salvage strategy for Gustilo type Ⅲ C lower limb injuries

作　　者：单贵霖 王根 孙圣亮 李飞 王剑利 SHAN Gui-lin;WANG Gen;SUN Sheng-liang;LI Fei;WANG Jian-li(Department of Surgery,Weifang Medical University,Weifang 261021,China;Institute of Traumatic Orthopedics of PLA,The 80 th Group Army Hospital,Army of PLA,Weifang 261021,China)

机构地区：[1]潍坊医学院外科学教研室,山东潍坊261021 [2]解放军第八十集团军医院全军创伤骨科研究所,山东潍坊261021

出　　处：《中国矫形外科杂志》2021年第14期1278-1281,共4页Orthopedic Journal of China

摘　　要：[目的]探讨GustiloⅢC型严重下肢损伤保肢方法的选择。[方法]回顾性分析本院2014年1月—2018年1月收治的30例GustiloⅢC型严重下肢毁损伤行保肢手术患者的资料。其中,胫腓骨骨折22例,股骨干骨折4例,股骨髁间骨折4例。依据患者全身与局部条件选择个性化救治。[结果]所有病例均进行急诊修复血管。9例患者一期锁定加压钢板内固定,21例患者进行外固定架固定。12例一期直接缝合创面,18例采用VSD负压吸引敷料覆盖一期创面,二期直接缝合5例,游离植皮5例,皮瓣覆盖8例,所有皮瓣均成活。所有患者均未发生肢体坏死和累及全身的严重感染。所有患者随访6~24个月,平均(11.32±1.34)个月。随着时间推移,30例患者VAS评分显著下降(P<0.05),膝、踝关节ROM均显著增加(P<0.05)。随访期间,所有患者均无因肢体功能丧失或慢性持续感染而行截肢术。至末次随访时,所有骨折均愈合。[结论]对于GustiloⅢC型严重下肢毁损伤,若能充分的进行术前评估并个性化及时手术处理,在骨关节固定的同时,更重视软组织覆盖修复的方法选择,可大大提高保肢成功率,并获得较满意患肢功能。[Objective] To explore the individualized surgical strategy for limb salvage of Gustilo type III C mangled lower extremity.[Methods] A retrospective study was conducted on 30 patients who received limb salvage for mangled lower limb in our hospital from January 2014 to January 2018. Among them, 22 patients had tibiofibular fractures, 4 had femoral shaft fractures, and 4 were of femoral intercondylar fractures. The personalized surgical strategy was selected based on the concrete condition of whole body and injured limb in each patient. Anastomosis of injured major arteries was performed in all the patients in emergency. With regard to fracture management, 9 patients got internal fixation with locking plate, whereas 21 patients were by using external frame. With regard to the wound treatment, 12 patients had wound closed by direct suture at primary stage, while the remaining 18 patients received vacuum sealing drainage(VSD) in the primary stage. Of the patients who used VSD primarily, 5 had the wound closed by direct suture, 5 underwent skin grafting, and 8 patients got free vascularized flap transplantation or flap transfer in the second or third stage of operation, all of them survived well. No necrosis of the affected limb, or serious local infection that deteriorated the general condition happened in anyone of the 30 patients. All patients were followed up for 6~24 months, with an average of(11.32±1.34) months. The VAS scores decreased significantly, while the knee and ankle ROMs increased significantly over time postoperatively(P<0.05). During follow-up, none of the patients had their limbs amputated due to loss of limb function or chronic persistent infection. By the time of the last follow-up, all patients got fracture healed, which was verified by radiographs. [Conclusion] There is still a larger success chance of limb preservation with sound limb function, if adequate preoperative evaluation, personalized and timely surgical treatments is handled for Gustilo type III mangled lower limb.

关 键 词：下肢毁损伤 保肢 GustiloⅢC型损伤 

分 类 号：R683.42[医药卫生—骨科学]