肢体大面积创伤阶梯治疗的临床疗效  

Clinical effects of escalation therapy for extensive limb wounds

作　　者：张凯[1] 肖滋润 杨涛[1] 杨松峰 张广超 江小萌 熊颖杰 周明武[1] 幸超峰[1] 陈佳 ZHANG Kai;XIAO Zirun;YANG Tao(Department of Orthopedics,No.988 Hospital of PLA Joint Logistics Support Force,Zhengzhou,Henan,450042,China)

机构地区：[1]中国人民解放军联勤保障部队第988医院骨科,河南郑州450042

出　　处：《实用手外科杂志》2024年第3期289-292,319,共5页Journal of Practical Hand Surgery

基　　金：河南省医学科技攻关计划联合共建项目(项目编号:LHGJ20220907、LHGJ20220908、LHGJ20220909、LHGJ20220912、LHGJ20210805、LHGJ20200793)。

摘　　要：目的探究应用阶梯策略治疗肢体大面积创伤的手术技巧及临床应用价值。方法选取2019年1月-2022年1月收治的21例四肢大面积皮肤软组织创伤患者,采用大创面阶梯治疗策略,入院后即刻全面评估病情、术中彻底清创、选取合适的骨折固定方式、修复血管神经及肌腱、VSD覆盖引流,待创面肉芽新鲜后游离植皮修复缩小创面,待植皮成活后行皮瓣修复等序惯阶梯化治疗。结果创面清洁时间7~21 d,平均(10.38±4.02)d,19例游离植皮全部一期成活,2例部分坏死经换药后瘢痕愈合。创面缩小后8例行局部转移皮瓣修复,7例行游离股前外侧皮瓣修复,5例行带蒂轴型皮瓣修复,1例行“螺旋桨”皮瓣联合游离股前外侧皮瓣修复,20例皮瓣均顺利成活,时间为9~16 d,平均(12.42±1.83)d,1例于术后14 h出现血管危象经手术探查后顺利成活。7例合并骨折者骨折线模糊时间为8~16周,平均(11.57±2.88)周,1例于术后6个月因骨折不愈合行切开植骨内固定术,于植骨术后4个月复查骨折愈合情况。术后随访4~14个月,平均(8.54±2.89)个月,18例痊愈,3例显效,总有效率为100%。结论阶梯治疗策略治疗肢体大面积创伤可以减少患者次生创伤,有效改善肢体外观及功能,缩短治疗时间,是治疗肢体大面积创伤一种安全有效的治疗策略。Objective To explore the surgical techniques and clinical application value of escalation therapy strategy in the treatment of extensive limb wounds.Methods From January 2019 to January 2022,21 patients with large area skin and soft tissue trauma of limbs were selected,which included 5 patients with upper limbs wounds and 16 patients with lower limbs wounds.The area of the defect was 12 cmx8 cm~31 cmx17 cm.All of the wounds were skin and soft tissue defects with tendon or bone exposured.After admission,patients were evaluated immediately.Debridement was performed thoroughly,with fracture fixation appropriately,blood vessels,nerves and tendons were repaired,VSD was covered.When the granulation tisue was fresh,free skin grafting was performed.And skin flaps repair was performed afer wound reduction.Results The cleaning time of limb wounds was 7-21(10.38±4.02)days,19 cases of free skin grafting survived in one stage,and 2 cases of partial necrosis healed after dressing change.8 cases were repaired by local flaps,7 cases were repaired by free anterolateral thigh flaps,5 cases were repaired by pedicled axial flaps after wound reduction,especially,1 case were repaired by propeller flap combined with free anterolateral thigh flap.20 flaps survived sucessfully,the time v was s 9-16(12.42+1.83)days,and one patient developed vascular crisis 14 hours afer operation and survived successfully after exploration.7 cases with fracture healed for 8-16(11.57±2.88)weeks.One case:un derwent open bone grafting and internal fixation due to fracture nonunion 6 months after operation.The fracture healing was rechecked 4 months after operation.After 4-14(8.54±2.89)months of follow-up,18 cases were cured,3 cases were effective,the total effective rate was 100%.Conclusion The escalation treatment strategy can effectively reduce the secondary trauma,improve the appearance and function of the limbs,and shorten the treatment time,which is a safe and effective treatment strategy.

关 键 词：肢体 大创面 阶梯治疗 修复 

分 类 号：R658[医药卫生—外科学]