Masquelet技术联合股前外侧皮瓣移植修复治疗Gustilo ⅢB、ⅢC型开放性胫骨骨折  

Masquelet technique combined with anterolateral thigh flap for treatment of Gustilo type ⅢB and ⅢC open tibial fractures

作　　者：鞠文 巨积辉 李雷 周正虎 邓伟 JU Wen;JU Jihui;LI Lei;ZHOU Zhenghu;DENG Wei(Deparment of Traumatic Orthopedics,Suzhou Ruihua Orthopedic Hospital,Suzhou,Jiangsu 215104,China)

机构地区：[1]苏州瑞华骨科医院创伤骨科,江苏苏州215104

出　　处：《中国骨与关节损伤杂志》2023年第4期366-370,共5页Chinese Journal of Bone and Joint Injury

基　　金：苏州市卫生健康委员会科技项目(LCZX202026)。

摘　　要：目的 探讨Masquelet技术联合股前外侧皮瓣移植修复治疗GustiloⅢB、ⅢC型开放性胫骨骨折的临床疗效。方法回顾性分析自2019-09—2021-07诊治的14例GustiloⅢB、ⅢC型开放性胫骨骨折,采用抗生素骨水泥覆盖骨外露创面、填塞局部骨缺损及软组织腔隙,游离股前外侧皮瓣移植覆盖创面。结果 14例皮瓣均成活,其中1例术后出现皮瓣血管危象,经探查后皮瓣成活。10例行皮瓣移植,4例行皮瓣和皮片移植覆盖创面。所有创面伤口均Ⅰ期愈合。6例改为钢板螺钉内固定,4例改为环形外固定架固定,4例继续使用原外固定架直至骨折愈合。14例均获得随访,随访时间7~18个月,平均10.7个月。本组术后7 d、14 d红细胞沉降率与C-反应蛋白水平均较术前改善,且趋于降低,差异有统计学意义(P<0.05)。14例均获得骨性愈合,愈合时间3~8个月,平均5.2个月。未出现伤口迟发感染,无固定物松动、断裂,末次随访见皮瓣质地、颜色正常。根据Johner-Wruhs功能评价标准:优10例,良3例,可1例,优良率92.9%,患肢外形功能恢复满意。结论 Masquelet技术联合股前外侧皮瓣移植修复治疗GustiloⅢB和ⅢC型开放性胫骨骨折能有效控制感染,缩短创面愈合时间,减少感染复发,疗效满意。Objective To explore the clinical effect of Masqueret technique combined with anterolateral thigh flap in the treatment of Gustilo typeⅢB andⅢC open tibial fractures.Methods The clinical data of 14 patients with GustiloⅢB andⅢC open tibial fractures from September 2019 to July 2021 were retrospectively analyzed.Antibiotic bone cement was used to cover the exposed wound,fill the local bone defect and soft tissue cavity,and free anterolateral femoral flap was used to cover the wound.Results All 14 flaps survived,of which 1 case had vascular crisis after operation,and the flap survived after exploration.The wound was covered by flap grafts in 10 cases,flap and skin grafts in 4 cases.All wounds healed at first stage.Six cases were replaced with plate and screw internal fixation,4 cases with circular external fixation,and 4 cases continued to use the original external fixation until the fracture healed.All the 14 cases were followed up for 7-18 months(mean 10.7 months).The erythrocyte sedimentation rate and C-reactive protein on the 7th and 14th days after operation tended to decrease compared with those before operation,the difference was statistically significant(P<0.05).All of the 14 cases achieved bony union,the healing time was 3 to 8 months(mean 5.2 months).There was no delayed infection of the wound,no loosening or breakage of the fixation,and the texture and color of the flap were normal at the last follow-up.According to the Johner-Wruhs functional evaluation criteria,10 cases were excellent,3 cases good,and 1 case fair.The excellent and good rate was 92.9%.The shape and function of the affected limb recovered satisfactorily.Conclusion Masquelet technique combined with anterolateral thigh flap for the treatment of GustiloⅢB andⅢC open tibial fractures can effectively control infection,shorten wound healing time,reduce recurrence,and have a satisfactory effect.

关 键 词：开放性胫骨骨折 股前外侧皮瓣 骨水泥 软组织缺损 骨缺损 

分 类 号：R687.3[医药卫生—骨科学]