CAJ | 학술논문

目的探讨下肢Gustilo ⅢB型、ⅢC型开放性损伤的保肢治疗方法及其疗效. 方法 2008年10月至2012年1月共收治82例下肢Gustilo ⅢB型、ⅢC型骨折患者,男64例,女18例;年龄21 ～64岁,平均45.3岁.骨折Gustilo分型:ⅢB型63例,ⅢC型19例.骨折部位:胫腓骨37例,胫骨6例,股骨9例,双侧胫腓骨5例,胫腓骨合并股骨11例,胫腓骨合并跖趾骨14例.肢体创伤严重程度评分:＞7分29例,6～7分32例,＜6分21例.均采用负压封闭引流(VSD)技术和延期组织瓣修复的保肢策略治疗.创面最终覆盖方式:直接缝合4例,植皮13例,肌瓣移植16例,局部或交腿筋膜瓣移植41例,游离皮瓣移植4例. 结果 82例患者术后获4 ～53个月(平均17个月)随访.78例患者保肢成功,4例(Gustilo ⅢB型、ⅢC型各2例)患者行二期膝下截肢术.保肢成功的78例患者平均负压吸引1.6次,平均手术3.7次.骨折一期愈合66例,愈合时间平均为6.4个月;延迟愈合7例;骨不连5例.9例患者出现创面感染现象,3例发生慢性骨髓炎. 结论对于下肢GustiloⅢB型、ⅢC型骨折患者,通过彻底清创及合理骨折固定,配合VSD技术及延期组织瓣修复,可有效恢复肢体功能.
목적 탐토하지Gustilo ⅢB형、ⅢC형개방성손상적보지치료방법급기료효. 방법 2008년10월지2012년1월공수치82례하지Gustilo ⅢB형、ⅢC형골절환자,남64례,녀18례;년령21 ～64세,평균45.3세.골절Gustilo분형:ⅢB형63례,ⅢC형19례.골절부위:경비골37례,경골6례,고골9례,쌍측경비골5례,경비골합병고골11례,경비골합병척지골14례.지체창상엄중정도평분:＞7분29례,6～7분32례,＜6분21례.균채용부압봉폐인류(VSD)기술화연기조직판수복적보지책략치료.창면최종복개방식:직접봉합4례,식피13례,기판이식16례,국부혹교퇴근막판이식41례,유리피판이식4례. 결과 82례환자술후획4 ～53개월(평균17개월)수방.78례환자보지성공,4례(Gustilo ⅢB형、ⅢC형각2례)환자행이기슬하절지술.보지성공적78례환자평균부압흡인1.6차,평균수술3.7차.골절일기유합66례,유합시간평균위6.4개월;연지유합7례;골불련5례.9례환자출현창면감염현상,3례발생만성골수염. 결론 대우하지GustiloⅢB형、ⅢC형골절환자,통과철저청창급합리골절고정,배합VSD기술급연기조직판수복,가유효회복지체공능.
Objective To explore the clinical skills and outcomes of limb-salvage surgery for Gustilo ⅢB and ⅢC fractures in the lower limb. Methods From October 2008 to January 2012,82 patients with Gustilo ⅢB and ⅢC fractures in the lower limb were treated in our hospital.They were 64 men and 18 women,aged 21 to 64 years (45.3 years on average).There were 63 cases of Gustilo ⅢB fractures and 19 cases of Gustilo ⅢC fractures.The fractures involved the tibiofibula in 37 cases,the tibia in 6,the femur in 9,the bilateral tibiofibula in 5,the tibiofibula and femur in 11,and the tibiofibula and metatarsophalangeal bones in 14.By the mangled extremity severity score (MESS) system,32 patients scored from 6 to 7 points,21 below 6 points and 29 above 7 points.The treatment included debridement,skeletal reconstruction,vacuum sealing drainage (VSD) and delayed flap reconstruction.For definitive wound coverage,4 wounds received primary closure,13 a split-skin graft,16 a muscle flap,41 a local or cross-leg fasciocutaneous flap and 4 a free flap. Results The 82 patients got a follow-up from 4 to 53 months (average,17 months).Of them,78 had their injured limbs saved and 4 had to undergo secondary amputation below the knee.On average,those with successful limb salvage underwent VSD for 1.6 times and surgery for 3.7 times. Sixty-six fractures were primarily healed after an average time of 6.4 months.Seven patients were afflicted by delayed union,5 by nonunion,9 by wound infection and 3 by chronic osteomyelitis. Conclusion Gustilo ⅢB and ⅢC fractures in the lower limb can be successfully salvaged by debridement,skeletal reconstruction,VSD and delayed flap reconstruction.