抗生素骨水泥预处理联合延迟一期髂腹股沟游离皮瓣移植治疗开放性多发掌骨骨折的近期临床疗效观察  

Clinical observation on the treatment of open multiple metacarpal fractures with pretreatment of antibiotic cement combined with delayed primary ilioinguinal free flap

作　　者：王祥[1] 李青松[1] 梁伟[1] 季亮[1] 胡兴峰[1] 刘文科 彭阳 罗其鑫 Wang Xiang;Li Qingsong;Liang Wei;Ji Liang;Hu Xingfeng;Liu Wenke;Peng Yang;Luo Qixin(Department of Orthopedics,The Fourth People's Hospital of Guiyang,Guiyang Guizhou,550001,China)

机构地区：[1]贵阳市第四人民医院骨科,贵州贵阳550001

出　　处：《生物骨科材料与临床研究》2024年第6期69-73,共5页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的探讨抗生素骨水泥预处理联合延迟一期髂腹股沟游离皮瓣移植治疗开放性多发掌骨骨折的近期临床疗效。方法自2019年7月至2022年7月,对贵阳市第四人民医院收治的16例手部开放性多发掌骨骨折并软组织缺损患者,均采用急诊清创骨折克氏针联合微型钢板固定,同时修复损伤的肌腱、血管、神经,5~7 d后利用髂腹股沟游离皮瓣修复手背部创面。患者年龄26~62岁,平均46岁;皮肤软组织缺损面积为5.0 cm×9.0 cm~7.0 cm×15.0 cm,其中合并肌腱断裂12例(无肌腱缺损),主要血管、神经损伤10例,掌指关节骨折脱位2例。所有患者急诊彻底清创后创面行抗生素骨水泥片覆盖5~7 d,采用髂腹股沟游离皮瓣覆盖。术后专科门诊、微信、电话定期随访,观察皮瓣外形及手指功能。结果术后随访8~24个月,平均14个月。16例患者骨折均一期愈合,皮瓣完全成活,1例发生浅表感染,经换药后愈合。观察皮瓣有不同程度的色素沉着,外观不臃肿,触摸质地柔软,供区愈合良好,均无感觉功能障碍。末次随访患者掌指关节平均主动活动度为(10±10)°~(60±15)°,远、近侧指骨间关节主动活动均正常,且按《中华医学会手外科学会上肢部分功能评定试用标准》评定:优9例,良6例,差1例。结论抗生素骨水泥预处理联合延迟一期髂腹股沟游离皮瓣移植治疗开放性多发掌骨骨折具有感染率低、皮瓣供区隐蔽等优点,近期临床疗效满意。Objective To explore the early clinical effect of antibiotic cement pretreatment combined with delayed primary ilioinguinal free flap for open multiple metacarpal fractures.Methods From July 2019 to July 2022,16 patients with open multiple metacarpal fractures and soft tissue defects in the hand were treated in the Fourth People's Hospital of Guiyang.Emergency debridement fractures were fixed with Kirschner wires combined with mini-plate to repair damaged tendons,blood vessels,and nerves.The ilioinguinal free flap was used to repair the wound on the back of the hand after 5-7 d.Patients ranged in age from 26 to 62 years,with a mean age of 46 years.The area of the soft tissue defect ranged from 5.0 cm×9.0 cm to 7.0 cm×15.0 cm,including 12 cases of tendon rupture(without tendon defect),10 cases of major vascular and nerve injury,2 cases of fracture and dislocation of the metacarpophalangeal joint.After thorough emergency debridement,antibiotic-loaded bone cements were applied to cover the wound surface for 5-7 d,and then covered with ilioinguinal free flap.After the operation,regular follow-up visits were conducted at the specialist clinic,WeChat,and telephone to observe the appearance of the flap and the function of the fingers.Results Postoperative follow-up ranged from 8 to 24 months,with an average of 14 months.After surgery,all the fractures healed initially,16 cases of flap had fully survived and 1 case developed superficial infection,which healed after dressing change.It was observed that the flap had varying degrees of pigmentation,the appearance was not bloated,the texture was soft to touch,the donor site healed well,and no functional or sensory disorders.The average active range of motion of the metacarpophalangeal joint in the last follow-up was from(10±10)°to(60±15)°,and the active range of motion of the distal and proximal interphalangeal joints was normal,and according to the trial standard of the upper limb functional assessment of the Chinese Medical Association,excellent in 9 cases,good in 6

关 键 词：开放性骨折 多发掌骨骨折 软组织缺损 内固定 髂腹股沟皮瓣 

分 类 号：R683.41[医药卫生—骨科学]