游离背阔肌皮瓣移植联合外固定治疗膝关节周围骨与软组织缺损  

Free latissimus dorsi myocutaneous flap transplantation combined with external fixation for bone and soft tissue defects around knee joint

作　　者：阿不来提·阿不拉[1] 任鹏[1] 古丽阿依夏木·赛买提 程二林 阿里木江·阿不来提[1] 艾合买提江·玉素甫[1,3] Abulaiti·Abula;REN Peng;Guliayixiamu·Saimaiti;CHENG Erlin;Alimujiang·Abulaiti;Aihemaitijiang·Yusufu(Department of Trauma and Microreconstructive Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi Xinjiang,830054,P.R.China;Department of Operating Room,the First Affiliated Hospital of Xinjiang Medical University,Urumqi Xinjiang,830054,P.R.China;Xinjiang Key Laboratory of Trauma Reconstruction,Urumqi Xinjiang,830054,P.R.China)

机构地区：[1]新疆医科大学第一附属医院骨科中心显微修复外科,乌鲁木齐830054 [2]新疆医科大学第一附属医院手术室,乌鲁木齐830054 [3]新疆创伤修复重建重点实验室,乌鲁木齐830054

出　　处：《中国修复重建外科杂志》2025年第4期488-494,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：新疆维吾尔自治区“天山英才”医药卫生高层次人才培养计划(TSYC202301B070、TSYC202301B056);新疆维吾尔自治区自然科学基金资助项目(2024D01C174);“天山英才”科技创新领军人才-高层次领军人才(2022TSYCLJ0026)。

摘　　要：目的探讨应用游离背阔肌皮瓣移植联合外固定治疗膝关节周围骨与软组织缺损的临床疗效。方法回顾性分析2016年1月—2023年7月收治的13例高能量创伤致膝关节周围骨与软组织缺损患者临床资料。其中男11例,女2例;年龄23~61岁,平均35.7岁。致伤原因:交通事故伤10例,机器绞伤2例,重物砸伤1例。Gustilo-Anderson分型为ⅢB型11例,ⅢC型2例。伤后创面感染2例,腘动脉损伤2例。伤后至皮瓣修复时间为40~49 d,平均27.5 d;创面大小为18 cm×13 cm~32 cm×20 cm,均伴有股骨远端骨缺损及股四头肌缺损。一期清创后采用封闭式负压引流联合外固定治疗,二期行游离背阔肌皮瓣移植修复软组织缺损,皮瓣切取范围为20 cm×15 cm~34 cm×22 cm。皮瓣供区9例直接拉拢缝合,4例因张力较大采用以肋间后动脉穿支为蒂的拱顶石皮瓣修复。皮瓣术后6~15个月,平均10.5个月,11例患者行膝关节骨性融合手术;2例因股骨远端和胫骨近端骨质缺损量大,行股骨和胫骨多节段骨搬移重建骨缺损。末次随访时记录皮瓣及供区恢复情况,采用美国肩肘外科医师协会(ASES)肩关节评分评估皮瓣切取侧肩关节功能,美国膝关节协会评分(KSS)评估患肢膝关节功能。结果术后所有皮瓣均成活,创面及供区切口均Ⅰ期愈合。13例患者均获随访,随访时间15~55个月,平均21.6个月。4例采用胸背部拱顶石穿支皮瓣修复供区患者术后周围瘢痕增生明显,但无挛缩且双侧乳房对称。末次随访时,皮瓣外观、质地良好;膝关节骨性融合良好,活动度和功能恢复良好;皮瓣切取侧肩关节功能未受明显影响,活动度满意,ASES评分为85~95分,平均89.5分。患肢膝关节KSS评分为75~90分,平均81.2分。结论游离背阔肌皮瓣移植联合外固定治疗高能量创伤导致的膝关节周围骨与软组织缺损,在修复骨与软组织缺损的同时重建膝关节稳定性,可有效保留肢体与软组织完整性Objective To investigate the effectiveness of free latissimus dorsi myocutaneous flap transplantation combined with external fixation in the treatment of bone and soft tissue defects around the knee joint.Methods A retrospective analysis was conducted on the clinical data of 13 patients with high-energy trauma-induced bone and soft tissue defects around the knee joint admitted between January 2016 and July 2023.Among them,11 were male and 2 were female,the age ranged from 23 to 61 years,with an average of 35.7 years.The causes of injury included 10 cases of traffic accident,2 cases of machine entanglement injury,and 1 case of heavy object crush injury.According to the Gustilo-Anderson classification,11 cases were typeⅢB and 2 cases were typeⅢC.Post-injury,2 cases had wound infection and 2 cases had popliteal artery injury.The time from injury to flap repair was 40-49 days,with an average of 27.5 days.The wound size was 18 cm×13 cm to 32 cm×20 cm,all accompanied by distal femoral bone defects and quadriceps muscle defects.After primary debridement,vacuum sealing drainage combined with external fixation was used for treatment.In the second stage,free latissimus dorsi myocutaneous flaps were transplanted to repair soft tissue defects,with the flap size ranging from 20 cm×15 cm to 34 cm×22 cm.The donor sites of 9 flaps were directly sutured,and 4 cases with large tension were repaired with a keystone flap based on the posterior intercostal artery perforator.At 6-15 months postoperatively,with an average of 10.5 months,11 patients underwent knee arthrodesis surgery;2 patients with large bone defects at the distal femur and proximal tibia underwent multi-segment bone transport reconstruction of the bone defect.At last follow-up,the recovery of the flap and the donor site was recorded,and the function of the shoulder joint was evaluated by the American Shoulder and Elbow Surgeons(ASES)score,and the function of the affected knee joint was evaluated by the Knee Society Score(KSS).Results All the flaps survived aft

关 键 词：骨缺损 软组织缺损 高能量创伤 外固定 游离皮瓣 膝关节 

分 类 号：R687.3[医药卫生—骨科学]