CAJ | 학술논문

目的探讨外固定架在膝、小腿血管损伤中的应用效果.方法回顾性分析2004年5月至2010年10月应用外固定架治疗的208例(234侧)膝及小腿血管损伤患者资料,男192例(217侧),女16例(17侧)；年龄14～67岁,平均39.6岁.损伤血管:腘动脉84例(86侧),胫前动脉36例(46侧),胫后动脉41例(49侧),胫前后动脉47例(53侧).伤肢远端完全缺血129例(141侧),不完全缺血79例(93侧).所有患者均行急诊手术.采用AO通用外固定架164例,创生镶嵌式外固定架37例,组合式外固定器7例.血管采用直接或大隐静脉桥接吻合.创面采用一期包扎、植皮、皮瓣移植和VSD负压吸引治疗.结果 194例保肢成功,14例因伤肢毁损严重及全身情况差于术后2～4 d截肢.术后43例患者创面自行愈合,127例二期行手术清创植皮或皮瓣治疗,24例一期行游离皮片或皮瓣移植覆盖.148例获得8个月～3年的完整随访,其中6例因患肢功能严重受限且伴发骨髓炎而自愿要求截肢.拆除外固定架时间1～18个月,平均7.2个月.102例骨折获得愈合,时间为3～13个月,平均5.6个月；40例出现骨折不愈合、骨缺损,行骨折内固定+植骨术或骨段滑移术,骨折均愈合.结论外固定架具有固定可靠,可在短时间内复位骨折,减少肢体缺血时间等优点,利于膝、小腿血管损伤的修复.
목적 탐토외고정가재슬、소퇴혈관손상중적응용효과.방법 회고성분석2004년5월지2010년10월응용외고정가치료적208례(234측)슬급소퇴혈관손상환자자료,남192례(217측),녀16례(17측)；년령14～67세,평균39.6세.손상혈관:객동맥84례(86측),경전동맥36례(46측),경후동맥41례(49측),경전후동맥47례(53측).상지원단완전결혈129례(141측),불완전결혈79례(93측).소유환자균행급진수술.채용AO통용외고정가164례,창생양감식외고정가37례,조합식외고정기7례.혈관채용직접혹대은정맥교접문합.창면채용일기포찰、식피、피판이식화VSD부압흡인치료.결과 194례보지성공,14례인상지훼손엄중급전신정황차우술후2～4 d절지.술후43례환자창면자행유합,127례이기행수술청창식피혹피판치료,24례일기행유리피편혹피판이식복개.148례획득8개월～3년적완정수방,기중6례인환지공능엄중수한차반발골수염이자원요구절지.탁제외고정가시간1～18개월,평균7.2개월.102례골절획득유합,시간위3～13개월,평균5.6개월；40례출현골절불유합、골결손,행골절내고정+식골술혹골단활이술,골절균유합.결론 외고정가구유고정가고,가재단시간내복위골절,감소지체결혈시간등우점,리우슬、소퇴혈관손상적수복.
Objective To investigate the effect of external fixator on repairing the vascular injuries in the knee and calf.Methods From May 2004 to October 2010,208 patients (234 sides) with vascular injuries in knee and calf,treated with external fixation,were retrospectively analyzed,including 192 males (217 sides) and 16 females (17 sides) with an average age of 39.6 years (range,14-67).Blood vessel damage:the popliteal artery injury in 84 patients (86 sides),the anterior tibial artery injury in 36 (46),the posterior tibial artery injury in 41(49),the anterior tibial artery and the posterior tibial artery injury in 47 (53).Complete ischemic of the injured distal limb existed in 129 patients(141 sides),incomplete ischemia in 79 patiets (93 sides).All patients underwent emergency surgery.The AO external fixators were used in 164 patients,the chuangsheng inlaid external fixators in 37,and the hybrid external fixators in 7.The injured vessels were anastomosed directly,or indirectly with great saphenous vein.The wounds were treated with phase Ⅰ bandage,skin grafts,flap transplantation or VSD suction.Results One hundred and ninty four patients obtained successful limb salvage; but 14 patients underwent amputation owing to serious damage of limb and poor general condition.One hundred and twenty seven patients underwent the second stage debridement combined with skin graft or flap transplantation; 24 patients underwent the first stage free skin graft or flap transplantation;wound cicatrized by oneself in 43 patients.One hundred and forty eight patients were followed up for 8 months to 3 years.External fixators were removed after an average of 7.2 months (range,1-18).The average healing time of fracture in 102 patients was 5.6 months (range,3-13).Forty patients suffered bone nonunion or bone defect; after treated by fracture fixation,bone graft or bone transport,all of them got bone union.Conclusion The external fixation can shorten operation time as well as the time of limb ischemia,which is an effective option on repairing vascular injuries in knee and calf.