中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
CHINESE JOURNAL OF ORTHOPAEDIC TRAUMA
2010年
5期
417-420
,共4页
创伤和损伤%感染%下肢%骨缺损%腓骨瓣
創傷和損傷%感染%下肢%骨缺損%腓骨瓣
창상화손상%감염%하지%골결손%비골판
Wounds and injuries%Infection%Lower extremity%Bone defects%Fibular skeletal flaps
目的 探讨下肢创伤后大段感染性骨缺损的分型以及修复方法. 方法 2002年3月至2008年12月共收治42例下肢创伤后大段感染性骨缺损患者,男29例,女13例;平均年龄34.2岁.感染性骨缺损部位:股骨3例,胫骨39例.根据其缺损特点分为3型:单纯大段感染性骨缺损(Ⅰ型)、大段感染性骨缺损并大面积皮肤软组织缺损(Ⅱ型)、大段感染性骨缺损并肢体短缩畸形(Ⅲ型),本组Ⅰ型6例,Ⅱ型35例,Ⅲ型1例.所有患者在彻底清创基础上分别应用单纯腓骨瓣移植或移位(6例)、腓骨皮瓣移植(31例)、腓骨瓣+股前外侧皮瓣移植(4例)、骨牵引延长+腓骨瓣移植(1例)同期进行修复. 结果 42例患者术后获6～41个月(平均26.3个月)随访.除2例因移植腓骨坏死而截肢、2例感染未能控制外,其余38例患者骨缺损均得到成功修复,下肢外形及功能恢复均满意.参照Johner-Wruhs疗效评定标准:优17例,良18例,可3例,差4例,优良率为83.3%.结论 下肢创伤后大段感染性骨缺损根据其缺损特点可分为3型;针对性应用不同形式的腓骨瓣,能同期修复下肢各种类型创伤后大段感染性骨缺损.
目的 探討下肢創傷後大段感染性骨缺損的分型以及脩複方法. 方法 2002年3月至2008年12月共收治42例下肢創傷後大段感染性骨缺損患者,男29例,女13例;平均年齡34.2歲.感染性骨缺損部位:股骨3例,脛骨39例.根據其缺損特點分為3型:單純大段感染性骨缺損(Ⅰ型)、大段感染性骨缺損併大麵積皮膚軟組織缺損(Ⅱ型)、大段感染性骨缺損併肢體短縮畸形(Ⅲ型),本組Ⅰ型6例,Ⅱ型35例,Ⅲ型1例.所有患者在徹底清創基礎上分彆應用單純腓骨瓣移植或移位(6例)、腓骨皮瓣移植(31例)、腓骨瓣+股前外側皮瓣移植(4例)、骨牽引延長+腓骨瓣移植(1例)同期進行脩複. 結果 42例患者術後穫6～41箇月(平均26.3箇月)隨訪.除2例因移植腓骨壞死而截肢、2例感染未能控製外,其餘38例患者骨缺損均得到成功脩複,下肢外形及功能恢複均滿意.參照Johner-Wruhs療效評定標準:優17例,良18例,可3例,差4例,優良率為83.3%.結論 下肢創傷後大段感染性骨缺損根據其缺損特點可分為3型;針對性應用不同形式的腓骨瓣,能同期脩複下肢各種類型創傷後大段感染性骨缺損.
목적 탐토하지창상후대단감염성골결손적분형이급수복방법. 방법 2002년3월지2008년12월공수치42례하지창상후대단감염성골결손환자,남29례,녀13례;평균년령34.2세.감염성골결손부위:고골3례,경골39례.근거기결손특점분위3형:단순대단감염성골결손(Ⅰ형)、대단감염성골결손병대면적피부연조직결손(Ⅱ형)、대단감염성골결손병지체단축기형(Ⅲ형),본조Ⅰ형6례,Ⅱ형35례,Ⅲ형1례.소유환자재철저청창기출상분별응용단순비골판이식혹이위(6례)、비골피판이식(31례)、비골판+고전외측피판이식(4례)、골견인연장+비골판이식(1례)동기진행수복. 결과 42례환자술후획6～41개월(평균26.3개월)수방.제2례인이식비골배사이절지、2례감염미능공제외,기여38례환자골결손균득도성공수복,하지외형급공능회복균만의.삼조Johner-Wruhs료효평정표준:우17례,량18례,가3례,차4례,우량솔위83.3%.결론 하지창상후대단감염성골결손근거기결손특점가분위3형;침대성응용불동형식적비골판,능동기수복하지각충류형창상후대단감염성골결손.
Objective To investigate the classification and its application in one-stage repair of massive posttraumatic bone defects which are infection-induced and refractory in lower extremities. Methods From March 2002 to December 2008, we treated 42 patients with massive posttraumatic refractory infection-induced bone defects in lower extremities. We classified the defects into 3 types: simple massive infection-induced bone defects (type Ⅰ), massive infection-induced bone and soft-tissue defects (type Ⅱ) and massive infection-induced bone defects plus limb shortening (type Ⅲ). After thorough debridement, various types of vascularized fibular grafts were used to repair the 3 kinds of defects accordingly. Simple fibular grafts were used in 6 cases, transplantation with fibular and skin flaps was used in 31 cases, fibular grafts combined with anterior lateral thigh flap in 4 cases, and one-stage limb lengthening and fibular graft in one. Results The follow-ups of 6 to 41 (average, 26. 3) months revealed that the refractory bone defects were repaired successfully in 38 cases, amputation due to necrosis of fibular grafts in 2 cases and uncontrolled infection in 2 cases. In the 38 cases, infections were controlled effectively, circulation of the traumatic limbs was good,contour and function were restored satisfactorily, and no obvious complication was found in donor limbs. By Johner-Wruhs evaluation, 17 cases were excellent, 18 cases good, 3 cases fair and 4 cases poor, with a total excellent and good rate of 83.33%. Conclusions Refractory and massive posttraumatic infection-induced bone defects in lower extremities can be classified into 3 types. They can be repaired using various types of vascularized fibular grafts according to the defect types at one-stage.
