Ilizarov外固定支架结合带蒂皮瓣转移治疗胫骨感染性骨不连伴皮肤软组织缺损的疗效分析  

Treatment of infected tibial nonunion plus soft tissue defects with an Ilizarov external fixator combined with pedicle flap transfer

作　　者：石博文 舒衡生 Shi Bowen;Shu Hengsheng(Department of Orthopedic Trauma,Tianjin Hospital Affiliated to Tianjin University,Tianjin 300211,China)

机构地区：[1]天津大学天津医院创伤骨科,天津300211

出　　处：《中华创伤骨科杂志》2023年第8期690-695,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨应用Ilizarov外固定支架结合带蒂皮瓣转移治疗胫骨感染性骨不连伴皮肤软组织缺损的手术方法及其疗效。方法回顾性分析2005年7月至2020年7月期间天津大学天津医院创伤骨科收治的35例胫骨感染性骨不连伴皮肤软组织缺损患者资料。男25例, 女10例;年龄(37.5±6.0)岁。原始创伤中开放性骨折27例, 闭合性骨折8例。病程8~42个月, 既往曾行1次手术者3例, 2次手术者7例, ≥3次手术者25例。所有患者均存在不同程度的皮肤软组织缺损或骨外露、创面窦道形成和贴骨瘢痕。转移皮瓣面积6 cm×5 cm~15 cm×10 cm。25例一期手术转移皮瓣及外固定支架固定;10例分期手术, 一期行局部清创负压封闭引流及皮瓣延迟术, 二期再行延迟皮瓣转移、Ilizarov外固定支架固定。术后观察患者皮瓣成活情况、肢体短缩情况、骨愈合情况及并发症发生情况。依照Ilizarov方法应用与研究协会(ASAMI)骨与功能结果评价标准评定肢体功能。结果所有患者术后获(23.8±7.4)个月随访, 均获得骨愈合。其中32例术后转移皮瓣成活, 创面一期修复, 感染未再复发, 获得了骨性愈合。3例皮瓣边缘部分坏死, 经换药后创面愈合。10例行皮瓣延迟术的患者, 皮瓣100%成活。所有患者肢体短缩(0.8±0.1)cm, 胫骨骨折愈合时间为(7.2±1.2)个月。按照ASAMI骨结果评价:优29例, 良6例;功能结果评价:优25例, 良8例, 可2例。结论应用Ilizarov技术结合皮瓣转移技术治疗胫骨感染性骨不连伴皮肤软组织缺损, 一期同时修复骨与软组织缺损, 有利于控制感染, 疗效可靠。Objective To investigate the clinical effects of Ilizarov external fixation combined pedicle flap transfer in the treatment of infected tibial nonunion plus soft tissue defects.Methods A retrospective study was performed to analyze the data of 35 patients with infected tibial nonunion plus soft tissue defects who had been admitted to Department of Orthopedic Trauma,Tianjin Hospital Affiliated to Tianjin University from July 2005 to July 2020.There were 25 males and 10 females with an age of(37.5±6.0)years.Their original traumas were 27 open and 8 closed fractures,with a disease course ranging from 8 to 42 months.Three patients had undergone 1 operation,7 patients 2 operations,and 25 patients 3 or more operations.All patients presented with different degrees of skin and soft tissue defects or bone exposure,wound sinus formation and bone scaring.The size of pedicle flaps transferred ranged from 6 cm×5 cm to 15 cm×10 cm.Surgical transfer of skin flap and external fixation were performed at one stage in 25 patients while staged surgery was performed in 10 patients.The first stage consisted of local debridement,vacuum sealing drainage,and delayed flap operation while the second stage consisted of delayed flap transfer and Ilizarov external fixation.The survival of skin flap,limb shortening,bony union and complications were observed after operation.The limb function was evaluated according to the criteria of The Association for the Study and Application of Methods of Ilizarov(ASAMI)for bone and functional results.Results All patients were followed up for(23.8±7.4)months.Fracture union was achieved in all.The flaps survived postoperatively,the wounds were repaired by the first intention,infection did not recur,and bony union was achieved in 32 patients.Partial necrosis of the flap edge occurred in 3 cases,but responded to dressing change.In the 10 patients undergoing delayed flap operation,100%of the flaps survived.In all patients,the limbs were shortened by(0.8±0.1)cm,and the tibial fractures got united after(7.2�

关 键 词：伊利扎罗夫技术 胫骨 感染 骨折 不愈合 外科皮瓣 

分 类 号：R687.3[医药卫生—骨科学]