前臂Gustilo ⅢB和ⅢC型骨折伴有复杂组织缺损急诊修复结果及相关因素分析  

Analysis of emergency reconstruction of forearm Gustilo Ⅲ B and Ⅲ C fracture with complex tissue defect: outcomes and related factors

作　　者：郑晓菊 李海军 李芳 王保山 王新宏 宋文斌 代创国 张忠 郑宇棋 ZHENG Xiaoju;LI Haijun;LI Fang;WANG Baoshan;WANG Xinhong;SONG Wenbin;DAI Chuangguo;ZHANG Zhong;ZHENG Yuqi(Department of Hand and Foot Microsurgery,Xi'an Fengcheng Hospital,Xi'an 710016,China)

机构地区：[1]西安凤城医院手足显微外科,西安710016

出　　处：《中华显微外科杂志》2023年第3期297-302,共6页Chinese Journal of Microsurgery

基　　金：西安市卫生健康委员会科研人才项目(2020yb75);陕西省自然科学基础研究计划项目(2023-JCYB-724)。

摘　　要：目的探讨急诊修复前臂GustiloⅢB、ⅢC型骨折伴复杂组织缺损治疗结果及其相关影响因素。方法收集西安凤城医院手足显微外科2014年1月-2022年2月肘关节至腕关节间的GustiloⅢB、ⅢC型骨折伴有大面积软组织或伴有血管、骨、肌腱、肌肉等复合缺损的病例98例,急诊进行清创、骨固定、游离皮瓣覆盖、骨移植(或骨水泥占位)或肌肉动力重建,通过影像资料、问卷、电话、微信、来院复诊对患者最新信息进行功能评定。采用秩和检验和卡方检验分别考察一般情况、病情、修复方法(嵌合组织移植组和单纯皮瓣移植组)等自变量与保肢、手术次数、创面愈合、功能评分、并发症等因变量间的关系。将P<0.05的差异进一步纳入回归方程,判断多个自变量和因变量之间的关系。结果本组术后随访6~96个月,平均71.1个月。嵌合组保肢率为95.1%、感染率8.50%、平均手术次数为(2.13±0.89)次;单纯皮瓣移植对照组保肢率为87.5%、感染率15.38%、手术次数为(2.62±0.64)次。Anderson评分优良率65.3%、上肢功能障碍评定(DASH)平均32.9(0~60)分。嵌合组和皮瓣组在保肢、感染因变量差异具有统计学意义(P<0.01)。缺血时间、骨固定方式在手术次数上差异具有统计学意义(P<0.05);嵌合组和单纯皮瓣移植组在骨固定方式、创面愈合情况上差异具有统计学意义(P<0.05或P<0.01)。基础病、是否骨缺损、Gustilo分型、骨固定方式在功能评分上差异存在统计学意义(P<0.05或P<0.01)。结论急诊修复前臂严重损伤,具有较高保肢率和功能效果。保肢率与损伤程度、肢体损伤严重程度评分(MESS)、缺血时间等自变量无关,而单纯皮瓣和嵌合移植与保肢率、感染、创面愈合有显著相关性;损伤程度、缺血时间、骨缺损与功能评定、手术次数、骨愈合有关。Objective To discuss outcomes of emergency repairing for GustiloⅢB andⅢC fractures of forearm with complicated tissue defects and the related influence factors.Methods From January 2014 to Feburary 2022,data of 98 cases of GustiloⅢB andⅢC fractures with large compound defects of soft tissue,blood vessel,bone,tendon or muscle from elbow to wrist were collected.Primary debridement,bone fixation,wound coverage by free flap,bone transfer(or bone cement filling)or dynamic reconstruction of muscle were completed with emergency surgery in Department of Hand and Foot Microsurgery,Xi'an Fengcheng Hospital.Postoperative follow-ups were conducted through outpatient clinic visits,telephone and WeChat reviews.Video clips,questionnaires and the latest information of patients were also analysed.Rank sum test and Chi-square test were used to examine the relationship between independent variables such as general condition,disease condition and surgical procedures of chimeric tissue transfer group and simple flap transfer group,together with dependent variables such as limb salvage,number of surgery,wound healing,function scores,and complications.P<0.05 were further included in the regression equation to discover the relationship between multiple independent variables and dependent variables.Results Follow-up lasted for 6-96 months,with an average of 71.1 months.In the chimeric group,the limb salvage rate was at 95.1%,with an infection rate of 8.50%and an average number of surgery was 2.13±0.89.In the simple flap transfer group,the limb salvage rate was at 87.5%,with an infection rate of 15.38%and an average number of surgery was 2.62±0.64.The good rate of Anderson score was 65.3%and the average score of Disability of the Arm,Shoulder and Hand(DASH)was 32.9(0-60)points for all the patients.There were significant differences in dependent variables of limb salvage and infection rate between the 2 groups(P<0.05).Ischemia time and method of bone fixation led to significant differences in number of surgery(P<0.05).Methods of

关 键 词：前臂损伤 Gustilo分型 缺血时间 外科皮瓣 嵌合组织移植 相关因素分析 

分 类 号：R658[医药卫生—外科学]