CAJ | 학술논문

目的探讨胫后动脉穿支皮瓣结合比目鱼肌肌瓣在治疗胫骨干内固定术后感染性骨与软组织缺损中的应用价值.方法 2006年12月至2009年5月收治12例胫骨干骨折内固定术后感染患者,男8例,女4例；年龄16 ～65岁,平均38.5岁.采用钢板固定9例,髓内钉固定2例,钢板加外固定支架固定1例.手术时间为内固定手术后5～8周,平均6.2周.术中去除内固定物,改用外固定支架固定,并行病灶清除、负压封闭引流,二期利用胫后动脉穿支皮瓣结合比目鱼肌肌瓣修复软组织缺损并填充死腔,创而愈合后若无感染复发,则3个月后行游离髂骨块移植修复骨缺损,定期复查以了解骨折愈合情况.结果病灶清除后余软组织缺损面积为5.0cm×7.0cm～7.0 cm× 10.0 cm,骨缺损体积为1.0cm×1.0 cm×2.0 cm～3.0cm×3.0cm×5.0 cm.胫后动脉穿支皮瓣面积为6.0cm×8.0 cm～8.0 cm×11.0 cm,比目鱼肌肌瓣体积为1.0cm×2.0cm×2.0cm～2.0 cm ×4.0 cm ×6.0cm.12例皮瓣完全成活,外形良好,创面愈合时间14 ～ 19 d,平均17.3d,骨折愈合时间6～12个月,平均8.2个月.所有患者术后均获11 ～36个月(平均21个月)随访.按Johner-Wruhs方法评定疗效:优9例,良2例,可1例,优良率为91.7％. 结论胫后动脉穿支皮瓣结合比目鱼肌肌瓣治疗胫骨干内固定术后感染性骨与软组织缺损,局部血运改善明显,抗感染能力增强,不会残留死腔,可降低复发几率,具有较好的应用前景.
목적 탐토경후동맥천지피판결합비목어기기판재치료경골간내고정술후감염성골여연조직결손중적응용개치.방법 2006년12월지2009년5월수치12례경골간골절내고정술후감염환자,남8례,녀4례；년령16 ～65세,평균38.5세.채용강판고정9례,수내정고정2례,강판가외고정지가고정1례.수술시간위내고정수술후5～8주,평균6.2주.술중거제내고정물,개용외고정지가고정,병행병조청제、부압봉폐인류,이기이용경후동맥천지피판결합비목어기기판수복연조직결손병전충사강,창이유합후약무감염복발,칙3개월후행유리가골괴이식수복골결손,정기복사이료해골절유합정황.결과 병조청제후여연조직결손면적위5.0cm×7.0cm～7.0 cm× 10.0 cm,골결손체적위1.0cm×1.0 cm×2.0 cm～3.0cm×3.0cm×5.0 cm.경후동맥천지피판면적위6.0cm×8.0 cm～8.0 cm×11.0 cm,비목어기기판체적위1.0cm×2.0cm×2.0cm～2.0 cm ×4.0 cm ×6.0cm.12례피판완전성활,외형량호,창면유합시간14 ～ 19 d,평균17.3d,골절유합시간6～12개월,평균8.2개월.소유환자술후균획11 ～36개월(평균21개월)수방.안Johner-Wruhs방법평정료효:우9례,량2례,가1례,우량솔위91.7％. 결론 경후동맥천지피판결합비목어기기판치료경골간내고정술후감염성골여연조직결손,국부혈운개선명현,항감염능력증강,불회잔류사강,가강저복발궤솔,구유교호적응용전경.
Objective To investigate the therapeutic effect of posterior tibial artery perforator flap plus soleus muscular flap in the treatment of postoperative infectious bone and soft-tissue defects following internal fixation of tibial shaft fractures.Methods From December 2006 to May 2009,12 cases of postoperative infection were admitted to our department following internal fixation of tibial shaft fractures in other medical institutions.They were 8 men and 4 women,16 to 65 years of age (average,38.5 years).Of them,9 were primarily treated with plating,2 with intramedullary nailing and one with combination of plating and external fixation.The secondary corrections were 5 to 8 weeks after the primary internal fixation.All the internal implants were removed before external fixators were used instead.Following debridement and vacuum sealing drainage (VSD),posterior tibial artery perforator flap plus soleus muscular flap was used to repair soft tissue defects and fill the dead space subsequently.Recurrence of infection was observed regularly.Three months after wound healing iliac bone grafting was performed to repair the tibial bone defects.X-ray examination was performed once a month to observe fracture healing.Results The areas of soft-tissue defect after focus clearance ranged from 5.0 cm × 7.0 cm to 7.0 cm × 10.0 cm,and the volumes of bone defect ranged from 1.0 cm × 1.0 cm × 2.0 cm to 3.0 cm × 3.0 cm × 5.0 cm.The areas of posterior tibial artery perforator flap ranged from 6.0 cm× 8.0 cm to 8.0 cm × 11.0 cm,and the volumes of soleus muscular flap ranged from 1.0 cm× 2.0 cm × 2.0 cm to 2.0 cm × 4.0 cm× 6.0 cm.The follow-up time ranged from 11 to 36 months,with an average of 21 months.All the flaps survived with good outline.The wound healing time was 14 to 19 days,with an average of 17.3 days.Fractures united within 6 to 12 months,with an average of 8.2 months.Recurrence of infection was not observed in all the 12 cases.By Johner-Wruhs classification,9 cases obtained excellent results,2 good and one fair,with a good to excellent rate of 91.7％.Conclusion In the treatment of postoperative infectious bone and soft-tissue defects following internal fixation of tibial shaft fractures,posterior tibial artery perforator flap plus soleus muscular flap can be highly recommended because the combination demonstrates advantages of reliable blood supply,strong anti-infection perfomance,thorough dead space filling,and diminished recurrence of infection.