显微外科技术结合Ilizarov技术治疗小腿毁损伤  

Microsurgical technique combined with Ilizarov technique for the treatment of severe lower leg trauma

作　　者：郭永明 李顺华 罗鸿 GUO Yongming;LI Shunhua;LUO Hong(Department of Orthopedics,Beijing Jishuitan Hospital,Guizhou Hospital,Guiyang,Guizhou,550000,China)

机构地区：[1]北京积水潭医院贵州医院创伤骨科,贵州贵阳550000

出　　处：《实用手外科杂志》2024年第1期54-56,60,共4页Journal of Practical Hand Surgery

摘　　要：目的探讨应用显微外科技术结合Ilizarov技术治疗小腿GustiloⅢC型毁损伤的临床疗效。方法回顾性分析2018年6月-2021年6月收治的GustiloⅢC型小腿毁损伤患者10例,男8例,女2例;左侧6例,右侧4例;年龄18~58岁;交通伤6例,机器伤4例;软组织缺损面积6cm×8 cm~16 cm×20 cm;骨缺损长度5~12 cm。入院后均根据伤情急诊以显微外科技术重建伤肢血运,二期采用植皮或游离皮瓣修复皮肤软组织缺损,三期以Ilizarov技术修复骨缺损。10例患者出院后均定期复查,小腿创面愈合情况,外固定支架是否稳固、有无偏斜,是否有创面或钉道感染,根据X线观察新生骨矿化情况,动态调整搬运速度。结果术后10例患者均保肢成功,软组织缺损、骨缺损均完全修复,骨折断端均愈合。10例均获随访,随访时间20~36个月,平均26个月。末次随访膝关节LEFS评分:优2例,良5例,可3例。末次随访踝关节AOFAS评分:优1例,良3例,可3例,差3例。结论应用显微外科技术结合Ilizarov技术治疗小腿GustiloⅢC型毁损伤,保肢率高,可恢复一定的肢体功能,是一种较理想的治疗方法。Objective To investigate the clinical efficacy of combining microsurgical techniques with the Ilizarov technique in treating Gustilo Type III-C severe lower leg trauma.Methods A retrospective analysis was conducted on 10 patients treated from June 2018 to June 2021 for Gustilo Type III-C lower leg trauma.This group included 8 males and 2 females;6 injuries on the left side and 4 on the right;ages ranging from 18 to 58 years.There were 6 cases of traffic accidents and 4 of machinery-related injuries.The area of soft tissue defect ranged from 6 cm×8 cm to 16 cm×20 cm,and bone defect length varied from 5 cm to 12 cm.All patients underwent emergency microsurgical reconstruction of the limb vasculature upon admission,followed by skin grafting or free skin flap for the repair of skin and soft tissue defects.In the third phase,the Ilizarov technique was used to repair bone defects.All 10 patients were regularly followed up post-discharge,with checks on lower leg wound healing,stability and alignment of the external fixation frame,presence of wound or pin tract infections,and observation of new bone mineralization via X-ray to dynamically adjust the transfer speed.Results Limb salvage was successful in all 10 patients with complete repair of soft tissue and bone defects,and all fracture ends healed.Follow-up ranged from 20 to 36 months,averaging 26 months.The final follow-up Lower Extremity Functional Scale(LEFS)score for knee joints was excellent in 2 cases,good in 5 cases,and fair in 3 cases.The final follow-up American Orthopaedic Foot and Ankle Society(AOFAS)ankle score was excellent in 1 case,good in 3 cases,fair in 3 cases,and poor in 3 cases.Conclusion The combination of microsurgical techniques with the Ilizarov technique for treating Gustilo Type III-C lower leg trauma provides a high rate of limb salvage and can restore certain limb functions,making it an ideal treatment method.

关 键 词：显微外科 ILIZAROV技术 小腿 GustiloⅢC型毁损伤 

分 类 号：R687.3[医药卫生—骨科学]