中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
CHINESE JOURNAL OF ORTHOPAEDIC TRAUMA
2014年
6期
461-464
,共4页
丛海波%王晓科%丁英杰%余志平%李长签
叢海波%王曉科%丁英傑%餘誌平%李長籤
총해파%왕효과%정영걸%여지평%리장첨
组织移植%软组织损伤%修复外科手术%骨搬运
組織移植%軟組織損傷%脩複外科手術%骨搬運
조직이식%연조직손상%수복외과수술%골반운
Tissue transplantation%Soft tissue defect%Reconstructive surgical procedures%Bone transportation
目的 探讨组织瓣移植结合骨搬运修复重建小腿大范围复合组织缺损(大面积软组织缺损合并大段骨缺损)的临床疗效.方法 回顾性分析2005年1月至2011年12月收治的92例小腿大范围复合组织缺损患者的临床资料,男71例,女21例;年龄19 ～56岁,平均38.3岁.所有患者术前均采用中医外敷法湿敷创面;后行亚急症皮瓣移植结合骨搬运治疗小腿大范围皮肤缺损合并大段骨缺损,肌皮瓣移植结合骨搬运重建毁损的肌肉功能并修复大段骨缺损;组织瓣移植术后,再采用水蛭地龙汤抗凝.结果 92例患者手术实施成功率达100％,无一例患者发生感染,吻合血管游离移植106块组织,除1例患者皮瓣远端部分干性坏死外,其他移植组织全部成活;手术次数平均为2.6次,骨愈合时间平均为256 d.92例患者术后获10 ～ 48个月(平均24.6个月)随访,按照国际Paley等的标准评定功能:优53例,良26例,可9例,差4例,优良率达85.9％.结论 对于小腿大范围复合组织缺损,组织瓣移植结合骨搬运可以最大限度地恢复患肢的功能,是一种较好的修复重建的方法.
目的 探討組織瓣移植結閤骨搬運脩複重建小腿大範圍複閤組織缺損(大麵積軟組織缺損閤併大段骨缺損)的臨床療效.方法 迴顧性分析2005年1月至2011年12月收治的92例小腿大範圍複閤組織缺損患者的臨床資料,男71例,女21例;年齡19 ～56歲,平均38.3歲.所有患者術前均採用中醫外敷法濕敷創麵;後行亞急癥皮瓣移植結閤骨搬運治療小腿大範圍皮膚缺損閤併大段骨缺損,肌皮瓣移植結閤骨搬運重建燬損的肌肉功能併脩複大段骨缺損;組織瓣移植術後,再採用水蛭地龍湯抗凝.結果 92例患者手術實施成功率達100％,無一例患者髮生感染,吻閤血管遊離移植106塊組織,除1例患者皮瓣遠耑部分榦性壞死外,其他移植組織全部成活;手術次數平均為2.6次,骨愈閤時間平均為256 d.92例患者術後穫10 ～ 48箇月(平均24.6箇月)隨訪,按照國際Paley等的標準評定功能:優53例,良26例,可9例,差4例,優良率達85.9％.結論 對于小腿大範圍複閤組織缺損,組織瓣移植結閤骨搬運可以最大限度地恢複患肢的功能,是一種較好的脩複重建的方法.
목적 탐토조직판이식결합골반운수복중건소퇴대범위복합조직결손(대면적연조직결손합병대단골결손)적림상료효.방법 회고성분석2005년1월지2011년12월수치적92례소퇴대범위복합조직결손환자적림상자료,남71례,녀21례;년령19 ～56세,평균38.3세.소유환자술전균채용중의외부법습부창면;후행아급증피판이식결합골반운치료소퇴대범위피부결손합병대단골결손,기피판이식결합골반운중건훼손적기육공능병수복대단골결손;조직판이식술후,재채용수질지룡탕항응.결과 92례환자수술실시성공솔체100％,무일례환자발생감염,문합혈관유리이식106괴조직,제1례환자피판원단부분간성배사외,기타이식조직전부성활;수술차수평균위2.6차,골유합시간평균위256 d.92례환자술후획10 ～ 48개월(평균24.6개월)수방,안조국제Paley등적표준평정공능:우53례,량26례,가9례,차4례,우량솔체85.9％.결론 대우소퇴대범위복합조직결손,조직판이식결합골반운가이최대한도지회복환지적공능,시일충교호적수복중건적방법.
Objective To report the clinical effects of treating massive multi-tissue defects at the leg with tissue flap transportation and bone transportation.Methods The clinical data was analyzed retrospectively of 92 patients who had been treated from January 2005 to December 2011 for massive soft tissue and large segmental bone defects at the leg.They were 71 males and 21 females,with a mean age of 38.3 years (range,19 to 56 years).They were treated by herbal dressing on wounds before operation.At the subacute stage,massive skin and large segmental bone defects were treated with skin flap transplantation plus bone transportation and damaged muscular function and large segmental bone defects were managed with musculocutaneous flap transplantation plus bone transportation.After operation,traditional Chinese medication was administered for anticoagulation in all cases.Results All operations were completed successfully without infection.Vascular anastomoses were conducted in free transplantation of 106 pieces of tissue.All transplanted tissues survived except for tip necrosis of one skin flap.On average,each patient received 2.6 operations and had an average duration of 256 days for treatment.The follow-up periods for all the patients ranged from 10 to 48 months (mean,24.6 months).According to Paley criteria,53 cases were rated as excellent,26 as good,9 as fair,and 4 as poor,giving a good to excellent rate of 85.9％.Conclusion As tissue flap transplantation plus bone transportation can restore the function of the leg as much as possible,it is an effective treatment of massive multi-tissue defects at the leg.
