一期皮瓣移植、二期胫骨骨膜瓣联合自体骨植骨治疗GustiloⅢB、ⅢC型小腿骨质与软组织缺损  

First stage flap transplantation and second stage tibial periosteum flap combined with autologous bone grafting for bone-skin defects of lower leg with Gustilo typeⅢB andⅢC injuries

作　　者：高钰凌 周君琳[1] 刘洋[1] 高顺红[2] GAO Yu-ling;ZHOU Jun-lin;LIU Yang;GAO Shun-hong(不详;Department of Orthopedics,Affiliated Beijing Chaoyang Hospital of Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院骨科,北京100020 [2]唐山市第二医院(华北理工大学附属骨科医院)手外科,河北063000

出　　处：《中国骨与关节损伤杂志》2022年第12期1266-1270,共5页Chinese Journal of Bone and Joint Injury

摘　　要：目的评估一期皮瓣移植、二期胫骨骨膜瓣联合自体髂骨植骨治疗GustiloⅢB、ⅢC型小腿骨质与软组织缺损的临床疗效。方法回顾性分析自2010-01—2019-12诊治的29例GustiloⅢB型和ⅢC型小腿骨质与软组织缺损,一期清创后封闭负压引流并外固定架固定,待创面组织新鲜后行皮瓣移植修复术(股前外侧游离皮瓣9例,腓肠神经营养血管皮瓣8例,腓肠肌皮瓣6例,腘窝中间皮动脉皮瓣4例,胫后动脉穿支皮瓣2例),二期采用胫骨骨膜瓣联合自体髂骨植骨修复骨缺损。取内侧骨膜瓣时钢板放置于外侧,取外侧骨膜瓣时钢板放置于内侧,放置钢板时应避开骨膜瓣与血管蒂,避免将钢板放置于骨膜瓣上而影响骨膜瓣血运。结果29例均获得随访,随访时间平均21.5(12~30)个月。自体髂骨移植后骨愈合良好,骨愈合时间4~8个月,平均4.5个月。骨折端有骨痂形成,髓腔再通,无内固定物松动断裂、感染、骨折畸形愈合发生。末次随访时所有患者患肢无疼痛,均恢复了负重和行走功能,膝、踝关节活动度良好。末次随访时Johner-Wruhs评分结果:优21例,良7例,可1例。结论对于GustiloⅢB、ⅢC型小腿骨质与软组织缺损患者,一期清创后封闭负压引流并外固定架固定,带蒂或游离皮瓣移植修复创面,二期采用胫骨骨膜瓣联合自体髂骨植骨修复骨缺损是一种可行的手术治疗方案,可取得满意的临床疗效。Objective To evaluate the effect of the first stage flap transplantation and second stage tibial periosteum flap combined with autologous bone grafting for bone-skin defects of lower leg with Gustilo typeⅢB andⅢC injuries.Methods Twenty-nine patients of tibial fractures with bone defect and soft tissue loss of Gustilo typeⅢB andⅢC injuries from January 2010to December 2019 were retrospectively analyzed.At the first stage,after primary debridement the wound was closed with negative pressure drainage and the external fixator was used for fixation,and pedicled or free flap repair was to be performed after fresh wound tissue appeared(9 cases of anterolateral thigh free flap,8 cases of sural neurovascular flap,6 cases of gastrocnemius myocutaneous flap,4 cases of popliteal fossa intermediate cutaneous artery flap,2 cases of posterior tibial artery perforator flap).At the second stage,tibial periosteal flap combined with autogenous iliac bone graft was used to repair bone defect.When taking the medial periosteal flap,the plate was placed on the outside of the tibia while placed on the inside of the tibia when taking the lateral periosteal flap.The plate was placed away from the periosteal flap and vascular pedicle to avoid interference of the blood flow of the periosteal flap.Results All 29 cases were followed up for 12 to 30 months(mean 21.5 months).All the autografts healed,and the healing time was 4-8 months(mean 4.5 months).Callus was formed,medullary cavity was recanalized,and there was no infection,malunion and loosening or fracture of the implant.There was no pain in the affected limb in the last follow-up for all patients.The weight-bearing and walking function were all restored.The knee and ankle joints moved well.In the last follow-up,according to the Johner-wrueh evaluation criteria,21 cases were excellent,7 cases good,and 1 case fair.Conclusion For the patients with bone defect and soft tissue loss of GustiloⅢB andⅢC injuries,after the first stage debridement,the wound is closed with negative pr

关 键 词：GustiloⅢB、ⅢC型损伤 胫骨缺损 软组织缺损 皮瓣移植 胫骨骨膜瓣 骨移植 

分 类 号：R687.3[医药卫生—骨科学]