实用手外科杂志
實用手外科雜誌
실용수외과잡지
CHINESE JOURNAL OF PRACTICAL HAND SURGERY
2014年
4期
429-431
,共3页
开放性骨折%股骨%骨质缺损%游离腓骨移植
開放性骨摺%股骨%骨質缺損%遊離腓骨移植
개방성골절%고골%골질결손%유리비골이식
Open fracture%Femur%Bone defect%Free Vascularized fibular graft
目的：探讨二期游离腓骨移植加钢板内固定在 GustiloⅢ型开放性股骨骨折并长段骨质缺损中的临床应用效果。方法对16例GustiloⅢ型开放性股骨骨折并长段骨质缺损患者，早期行彻底清创、外固定架固定骨折，创面分别给予负压封闭引流（vacuum sealing drainage, VSD）或用无菌敷料覆盖，定期伤口换药。术后根据肉芽组织生长情况分别行植皮、邻近皮瓣转移或游离皮瓣移植修复创面。待创面完全愈合，拆除外固定架，二期行游离腓骨移植加钢板内固定治疗。结果所有病例均获随访，随访时间9个月~2.5年，平均1.5年。移植腓骨全部成活，股骨骨折均骨性愈合，愈合时间4~9个月。患肢均恢复正常负重行走，随访期间无再骨折。腓骨供区伤口愈合良好，膝、踝关节功能不受限。无踝关节不稳定及外翻畸形发生。结论早期彻底清创、外固定架固定骨折，待创面完全愈合，拆除外固定架，行游离腓骨移植加钢板内固定是治疗GustiloⅢ型开放性股骨骨折并长段骨质缺损的一种有效方法。
目的：探討二期遊離腓骨移植加鋼闆內固定在 GustiloⅢ型開放性股骨骨摺併長段骨質缺損中的臨床應用效果。方法對16例GustiloⅢ型開放性股骨骨摺併長段骨質缺損患者，早期行徹底清創、外固定架固定骨摺，創麵分彆給予負壓封閉引流（vacuum sealing drainage, VSD）或用無菌敷料覆蓋，定期傷口換藥。術後根據肉芽組織生長情況分彆行植皮、鄰近皮瓣轉移或遊離皮瓣移植脩複創麵。待創麵完全愈閤，拆除外固定架，二期行遊離腓骨移植加鋼闆內固定治療。結果所有病例均穫隨訪，隨訪時間9箇月~2.5年，平均1.5年。移植腓骨全部成活，股骨骨摺均骨性愈閤，愈閤時間4~9箇月。患肢均恢複正常負重行走，隨訪期間無再骨摺。腓骨供區傷口愈閤良好，膝、踝關節功能不受限。無踝關節不穩定及外翻畸形髮生。結論早期徹底清創、外固定架固定骨摺，待創麵完全愈閤，拆除外固定架，行遊離腓骨移植加鋼闆內固定是治療GustiloⅢ型開放性股骨骨摺併長段骨質缺損的一種有效方法。
목적：탐토이기유리비골이식가강판내고정재 GustiloⅢ형개방성고골골절병장단골질결손중적림상응용효과。방법대16례GustiloⅢ형개방성고골골절병장단골질결손환자，조기행철저청창、외고정가고정골절，창면분별급여부압봉폐인류（vacuum sealing drainage, VSD）혹용무균부료복개，정기상구환약。술후근거육아조직생장정황분별행식피、린근피판전이혹유리피판이식수복창면。대창면완전유합，탁제외고정가，이기행유리비골이식가강판내고정치료。결과소유병례균획수방，수방시간9개월~2.5년，평균1.5년。이식비골전부성활，고골골절균골성유합，유합시간4~9개월。환지균회복정상부중행주，수방기간무재골절。비골공구상구유합량호，슬、과관절공능불수한。무과관절불은정급외번기형발생。결론조기철저청창、외고정가고정골절，대창면완전유합，탁제외고정가，행유리비골이식가강판내고정시치료GustiloⅢ형개방성고골골절병장단골질결손적일충유효방법。
Objective To explore the practical effect of treatment of type Ⅲ open femur fracture and massive bone defect with free Vascularized fibular graft and fixed with plates later. Methods 16 cases of type Ⅲ open femur fracture and massive bone defect were treated by early thorough debridement. The bone was external fixation. The wound was closed with VSD or sterile dressing that regularly replace. According to the growth of the granulation tissue after operation, the wound was healed with skin graft, nearby flap or free flap. After the wound was completely healed, the external fixators was removed. The type Ⅲ open femur fracture and massive bone defect was treated with free Vascularized fibular graft and fixed with plates. Results All cases were reviewed. The follow-up was 9 to 28 months ( averaging 18 months). All Fibular graft were completely survived and all femur fracture were completely healed, the healing time was 4 to 9 months. The limbs walking were normal, no one was re-fracture. The wounds of fibula donor were healed. No one has ankle instability and valgus deformity. Conclusion It's a effective method to treat type Ⅲ open femur fracture and massive bone defect with free Vascularized fibular graft and fixed with plates later.
