CAJ | 학술논문

目的探讨股前外侧皮瓣在Gustilo ⅢB型小腿开放性骨折软组织缺损修复中的应用价值.方法对GustiloⅢB胫骨骨折合并软组织缺损42例,分别行股前外侧皮瓣急诊修复创面10例,早期修复创面16例和晚期修复创面16例,术后随访,对各组疗效进行分析.结果移植皮瓣全部成活,无截肢病例,术后随访11～47个月,骨愈合时间6～13个月.和急诊、早期修复组相比,晚期修复组骨折愈合时间延长,骨感染、骨不连发生率明显升高,76%的病例需要行二期骨移植修复骨缺损和骨不连,下肢功能评分低于前两组.结论对Gustilo Ⅲ B型骨折尽早行创面修复手术,可以缩短治疗周期,改善治疗效果,对严重开放性骨折创伤的治疗有较大临床指导意义.
목적 탐토고전외측피판재Gustilo ⅢB형소퇴개방성골절연조직결손수복중적응용개치.방법 대GustiloⅢB경골골절합병연조직결손42례,분별행고전외측피판급진수복창면10례,조기수복창면16례화만기수복창면16례,술후수방,대각조료효진행분석.결과 이식피판전부성활,무절지병례,술후수방11～47개월,골유합시간6～13개월.화급진、조기수복조상비,만기수복조골절유합시간연장,골감염、골불련발생솔명현승고,76%적병례수요행이기골이식수복골결손화골불련,하지공능평분저우전량조.결론 대Gustilo Ⅲ B형골절진조행창면수복수술,가이축단치료주기,개선치료효과,대엄중개방성골절창상적치료유교대림상지도의의.
Objective To investigate the clinical results of the anterolateral thigh free flaps for the soft tissue coverage of Gustilo grade-Ⅲ B open bone fractures in lower extremities.Methods The anterolateral thigh free flaps were applied to treat 42 Gustilo grade-11Ⅲ B open fractures.Ten flaps were performed through an emergency procedure.Sixteen were performed at early stage and the other 16 were performed at later stage .The results of the therapy were analyzed after long time follow up. Results All limbs were salvaged and all the flaps survived without protracted course to obtain soft tissue coverage.The follow up ranged 11 to 47 months.The healing time of the bones were significant prolonged in the later stage therapy group compared with the emergency therapy group and the early stage therapy group.In the later stage therapy group,the incidences of the bone infection and nonunion were also higher than the other two groups,and the second stage bone transplantation to repair bone defect and nonunion were needed in 76% patients in this group.The lower limb functions of the later stage treated group were worse than those of the other two groups.Compared to the early stage treated group,better lower limb functions could be obtained in the emergency treated group. Conclusion Delayed soft tissue coverage resulted in higher incidence of complications.The immediate soft tissue coverage of severely injured limbs complicated by Gustilo grade-Ⅲ B open fractures and massive soft tissue defects had the advantages over traditional methods.Hard work though it was,one-stage soft tissue coverage using anterolateral thigh free flaps could obtain better lower limb function.