中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2009年
4期
298-302
,共5页
徐永清%朱跃良%李军%丁晶%汤逊%陆声%林月秋%郭远发%徐小山%阮默%马涛%李春晓%师继红%汪新民
徐永清%硃躍良%李軍%丁晶%湯遜%陸聲%林月鞦%郭遠髮%徐小山%阮默%馬濤%李春曉%師繼紅%汪新民
서영청%주약량%리군%정정%탕손%륙성%림월추%곽원발%서소산%원묵%마도%리춘효%사계홍%왕신민
腿损伤%胫骨骨折%外科皮瓣%外固定器
腿損傷%脛骨骨摺%外科皮瓣%外固定器
퇴손상%경골골절%외과피판%외고정기
Leg injuries%Tibial fractures%Surgical flaps%External fixators
目的 总结结合不同的皮瓣和外固定架治疗严重胫骨干骨折的经验.方法 1990-2007年,共治疗GustiloⅢB和GustiloⅢC型胫骨干骨折190例,其中GustiloⅢB型160例,GustiloⅢC型30例.男169例,女21例;平均年龄42.5岁.交通伤132例,机器压砸伤32例,石块砸伤26例.治疗措施包括抗生素、清创、植皮、各种组织瓣(游离胸脐皮瓣20例,腓肠神经营养血管皮瓣108例,隐神经营养血管皮瓣12例,腓浅神经营养血管皮瓣2例,筋膜皮瓣26例,腓肠肌内、外头肌皮瓣22例)、各种外固定架(半环架84例,单边轴动力外固定架12例,AO外固定架12例,潍坊三维外固定架42例,组合式外固定架40例).平均随访7.3年.结果 所有皮瓣成活.186例骨折愈合,平均骨愈合时间:84例半环架为7.5个月,8例单边轴动力外固定架11.2个月,12例AO外固定架8.5个月,42例潍坊三维外固定架8.1个月,40例组合式外固定架7.8个月.除半环架外,其他外固定架都需植骨.4例骨折未愈合,为单边轴动力外固定架固定后发生骨髓炎,经再次手术后愈合.最近随访发现所有患者的膝、踝关节功能正常,无患肢疼痛.结论 皮瓣与外固定架结合是治疗GustiloⅢB和GustiloⅢC型胫骨干骨折的较好方法.
目的 總結結閤不同的皮瓣和外固定架治療嚴重脛骨榦骨摺的經驗.方法 1990-2007年,共治療GustiloⅢB和GustiloⅢC型脛骨榦骨摺190例,其中GustiloⅢB型160例,GustiloⅢC型30例.男169例,女21例;平均年齡42.5歲.交通傷132例,機器壓砸傷32例,石塊砸傷26例.治療措施包括抗生素、清創、植皮、各種組織瓣(遊離胸臍皮瓣20例,腓腸神經營養血管皮瓣108例,隱神經營養血管皮瓣12例,腓淺神經營養血管皮瓣2例,觔膜皮瓣26例,腓腸肌內、外頭肌皮瓣22例)、各種外固定架(半環架84例,單邊軸動力外固定架12例,AO外固定架12例,濰坊三維外固定架42例,組閤式外固定架40例).平均隨訪7.3年.結果 所有皮瓣成活.186例骨摺愈閤,平均骨愈閤時間:84例半環架為7.5箇月,8例單邊軸動力外固定架11.2箇月,12例AO外固定架8.5箇月,42例濰坊三維外固定架8.1箇月,40例組閤式外固定架7.8箇月.除半環架外,其他外固定架都需植骨.4例骨摺未愈閤,為單邊軸動力外固定架固定後髮生骨髓炎,經再次手術後愈閤.最近隨訪髮現所有患者的膝、踝關節功能正常,無患肢疼痛.結論 皮瓣與外固定架結閤是治療GustiloⅢB和GustiloⅢC型脛骨榦骨摺的較好方法.
목적 총결결합불동적피판화외고정가치료엄중경골간골절적경험.방법 1990-2007년,공치료GustiloⅢB화GustiloⅢC형경골간골절190례,기중GustiloⅢB형160례,GustiloⅢC형30례.남169례,녀21례;평균년령42.5세.교통상132례,궤기압잡상32례,석괴잡상26례.치료조시포괄항생소、청창、식피、각충조직판(유리흉제피판20례,비장신경영양혈관피판108례,은신경영양혈관피판12례,비천신경영양혈관피판2례,근막피판26례,비장기내、외두기피판22례)、각충외고정가(반배가84례,단변축동력외고정가12례,AO외고정가12례,유방삼유외고정가42례,조합식외고정가40례).평균수방7.3년.결과 소유피판성활.186례골절유합,평균골유합시간:84례반배가위7.5개월,8례단변축동력외고정가11.2개월,12례AO외고정가8.5개월,42례유방삼유외고정가8.1개월,40례조합식외고정가7.8개월.제반배가외,기타외고정가도수식골.4례골절미유합,위단변축동력외고정가고정후발생골수염,경재차수술후유합.최근수방발현소유환자적슬、과관절공능정상,무환지동통.결론 피판여외고정가결합시치료GustiloⅢB화GustiloⅢC형경골간골절적교호방법.
Objective To discuss experiences in reconstruction of severe tibial shaft fractures by using different flaps and external fixations.Methods The study involved 190 patients with type GustiloⅢB Ⅲ C (160 patients) and GustiloⅢC (30 patients) tibial shaft fractures treated from 1990 to 2007.There were 169 males and 21 females,at average age of 42.5 years.The injury causes included traffic accidents in 132 patients,machine accidents in 32 and stone smashing in 26.The management procedure consisted of administration of antibiotics,serial debridement and different flap grafting (including free thoracoumbilical flaps in 20 patients,sural neurocutaneous vascular flaps in 108,saphenous neurocutane ous vascular flaps in 12,superficial peroneal neurocutaneous flap in two,fasciocutaneous flaps in 26 and gastrocnemius muscular flaps in 22) and different external fixators (half-ring fixators in 84 patients,unilateral axial dynamic fixators in 12,AO fixators in 10,Weifang fixators in 42 and hybrid fixators in 40).The average follow-up was 7.3 years.Results All flaps survived.Of all,186 patients obtained fracture healing,with mean fracture healing time varying in different patients treated with different external fixators:7.5 months for 84 patients treated with half-ring fixators,11.2 months for eight with unilateral axial dynamic fixators,8.5 months for 12 with AO fixators ,8.1 months for 42 with Weifang fixators and 7.8 months for 40 with assembly fixators.Except for half-ring fixation,the other fixators needed necessary bone graft.Four patients treated with unilateral axial dynamic fixators resulted in nonunion due to osteo myelitis.The latest follow up showed that the function of the ankle and knee was normal,with no pain.Conclusion Combination of half-ring external fixators with various flaps provides good method for treatment of Gustilo ⅢB and ⅢC tibial shaft fractures.
