CAJ | 학술논문

目的探讨GustiloⅢB、ⅢC型小腿及足踝部开放性骨折一期修复与重建的临床疗效及手术要点.方法回顾性分析2001年1月至2012年4月收治的160例GustiloⅢB、ⅢC型小腿及足踝部开放性骨折患者,男103例,女57例;平均年龄为36.3岁.骨折部位及Gustilo分型:胫骨干1 13例(ⅢB型91例,ⅢC型22例),胫骨远端4例(ⅢB型3例,ⅢC型1例),足踝部43例(ⅢB型37例,ⅢC型6例).受伤至手术时间为3～37 h,平均12.7h.彻底清创后应用穿支皮瓣、皮神经营养血管皮瓣、传统轴型皮瓣及肌皮瓣、局部皮瓣一期修复关键创面,选择外固定支架(121例)、钢板(20例)、螺钉或克氏针(14例)及髓内钉(5例)确定性固定骨折,同时完成其他必要的肢体结构及功能重建.结果本组患者平均住院时间为28.0 d(9 ～76 d),关键创面均经初次手术获得修复.除1例GustiloⅢC型胫腓骨骨折患者因主诉伤肢持续性疼痛而截肢外,其余159例保肢成功患者术后获12～ 83个月(平均21.3个月)随访.随访期间均未发生严重或持续的骨感染,骨性愈合时间为6～19个月(平均11.7个月),肢体功能、外形恢复满意.结论应用标准的修复重建外科技术及骨折固定技术一期修复与重建GustiloⅢB、ⅢC型小腿及足踝部开放性骨折可显著缩短治疗周期,减少并发症;新鲜创面解剖清晰,手术更为灵活;仅修复关键创面可减少供区牺牲,避免外形臃肿.
목적 탐토GustiloⅢB、ⅢC형소퇴급족과부개방성골절일기수복여중건적림상료효급수술요점.방법 회고성분석2001년1월지2012년4월수치적160례GustiloⅢB、ⅢC형소퇴급족과부개방성골절환자,남103례,녀57례;평균년령위36.3세.골절부위급Gustilo분형:경골간1 13례(ⅢB형91례,ⅢC형22례),경골원단4례(ⅢB형3례,ⅢC형1례),족과부43례(ⅢB형37례,ⅢC형6례).수상지수술시간위3～37 h,평균12.7h.철저청창후응용천지피판、피신경영양혈관피판、전통축형피판급기피판、국부피판일기수복관건창면,선택외고정지가(121례)、강판(20례)、라정혹극씨침(14례)급수내정(5례)학정성고정골절,동시완성기타필요적지체결구급공능중건.결과 본조환자평균주원시간위28.0 d(9 ～76 d),관건창면균경초차수술획득수복.제1례GustiloⅢC형경비골골절환자인주소상지지속성동통이절지외,기여159례보지성공환자술후획12～ 83개월(평균21.3개월)수방.수방기간균미발생엄중혹지속적골감염,골성유합시간위6～19개월(평균11.7개월),지체공능、외형회복만의.결론 응용표준적수복중건외과기술급골절고정기술일기수복여중건GustiloⅢB、ⅢC형소퇴급족과부개방성골절가현저축단치료주기,감소병발증;신선창면해부청석,수술경위령활;부수복관건창면가감소공구희생,피면외형옹종.
Objective To explore one-stage reconstruction of open fractures of leg,ankle and foot of Gustilo types Ⅲ B and ⅢC.Methods From January 2001 to April 2012,160 open fractures of leg,ankle and foot of Gustilo types Ⅲ B and Ⅲ C were treated with one-stage reconstruction.They were 103 men and 57 women,with an average age of 36.3 years.There were 113 cases of tibial shaft fracture (type ⅢB in 91 and type ⅢC in 22),4 cases of tibial distal end fracture (ⅢB in 3 and type ⅢC in one),and 43 cases of ankle and foot fracture (ⅢB in 37 and type ⅢC in 6).Time from injury to surgery ranged from 3 to 37 hours,averaging 12.7 hours.After thorough debridement,crucial soft-tissue wounds were covered with surgical flaps,such as perforator flap,neurovascular flap,traditional axial skin or muscular flap and even local flap.The fractures were reduced and fixated definitively using external frames in 121 cases,plates in 20 cases,screws and/or K-wires in 14 cases,and intramedullary nails in 5 cases.Other limb reconstructions included neurovascular repair,transposition of the tendon and nerve,and joint stabilization of ankle and foot.Results Mean in-hospital time was 28.0 days (ranged from 9 to 76 days).Crucial wounds were repaired primarily.The limbs were savaged successfully in 159 cases while amputation was performed in one case of tibiofibular fracture of Gustilo type Ⅲ C 2 months after primary operation because of consistent and severe pain.Follow-ups ranged from 12 to 83 months (average,21.3 months).No severe or persistent infection occurred and bone union time ranged from 6 to 19 months (average,11.7 months) with satisfactory aesthetic and functional results.Conclusions One-stage reconstruction of open fractures of leg,ankle and foot of Gustilo types Ⅲ B and Ⅲ C with standard techniques of plastics and fracture management can significantly simplify the procedures and reduce complications.In addition,fresh wounds are easier to get repaired.Moreover,flap coverage of only crucial defects but not the whole wounds can minimize donor sacrifice and recipient bulking.