CAJ | 학술논문

背景:肘关节开放骨折随着工伤事故发生率增高而迅速增高,骨折往往同时伴有严重的软组织损伤.目前采用自体植皮负压封闭引流联合外固定架治疗开放性骨折已被广泛报道.目的:探讨自体植皮负压封闭引流联合外固定架修复复杂重度开放性肘关节骨折的特点.方法:收集天津医科大学总医院骨科2009年1月至2013年12月采用自体植皮负压封闭引流联合外固定架治疗的复杂重度开放性肘关节骨折患者41例,均一期常规清创、外固定架固定并联合负压封闭引流封闭创面,创面有新鲜肉芽组织覆盖后,二期植皮或皮瓣转移修复创面.结果与结论:41例患者随访时间为8-22个月,平均13个月.外固定时间为8-13个月,平均9.8个月.开放性创面Ⅱ期植皮或皮瓣移植手术后均完全愈合.31例患者骨折Ⅰ期愈合,7例延迟愈合,3例不愈合,行髂骨植骨后 8-12 个月骨折完全愈合.41 例重度开放性肘关节骨折患者肢体功能恢复优良率为 73%.其中Gustilo Ⅱ型患者肢体功能恢复更佳.提示自体植皮负压封闭引流联合外固定架治疗复杂重度开放性肘关节骨折疗效满意.
배경:주관절개방골절수착공상사고발생솔증고이신속증고,골절왕왕동시반유엄중적연조직손상.목전채용자체식피부압봉폐인류연합외고정가치료개방성골절이피엄범보도.목적:탐토자체식피부압봉폐인류연합외고정가수복복잡중도개방성주관절골절적특점.방법:수집천진의과대학총의원골과2009년1월지2013년12월채용자체식피부압봉폐인류연합외고정가치료적복잡중도개방성주관절골절환자41례,균일기상규청창、외고정가고정병연합부압봉폐인류봉폐창면,창면유신선육아조직복개후,이기식피혹피판전이수복창면.결과여결론:41례환자수방시간위8-22개월,평균13개월.외고정시간위8-13개월,평균9.8개월.개방성창면Ⅱ기식피혹피판이식수술후균완전유합.31례환자골절Ⅰ기유합,7례연지유합,3례불유합,행가골식골후 8-12 개월골절완전유합.41 례중도개방성주관절골절환자지체공능회복우량솔위 73%.기중Gustilo Ⅱ형환자지체공능회복경가.제시자체식피부압봉폐인류연합외고정가치료복잡중도개방성주관절골절료효만의.
BACKGROUND:The incidence of open fracture of the elbow joint is increased rapidly with an increased number of accidents. Fractures are often accompanied by severe soft tissue injuries. At present, a combined therapy of autologous skin grafting, vacuum sealing drainage and external fixation for the treatment of open fractures has been widely reported. OBJECTIVE:To investigate the characteristics of the combined therapy of autologous skin grafting, vacuum sealing drainage, and external fixation for repair of complex and severe open fracture of the elbow joint. METHODS:A total of 41 patients with complex and severe open fracture of the elbow joint who received the combined therapy of autologous skin grafting, vacuum sealing drainage and external fixation during January 2009 to December 2013 in General Hospital of Tianjin Medical University, China were selected. Al patients were treated with routine debridement, external fixation and vacuum sealing drainage to cover wound during the first period. During the second period, autologous skin grafting or flap transfer was used to repair wound when the fresh granulation tissue covered the wound. RESULTS AND CONCLUSION:The postoperative folow-up period of these 41 patients was 8-22 months, with an average period of 13 months. External fixation period was 8-13 months with an average period of 9.8 months. The open wounds were completely healed after autologous skin grafting or skin flaps transfer. Fractures were healed in 31 patients during the first period. There were 7 cases of delayed union, 3 cases of nonunion. Al fractures were completely healed during 8-12 months after iliac bone grafting. The excelent and good rate of limb function recovery was 73.1% among 41 patients with severe open fracture of the elbow joint. The limb function of Gustilo II patients better recovered. These results suggest that the clinical effect of the combined therapy of autologous skin grafting, vacuum sealing drainage and external fixation for the treatment of complex and severe open fractures of the elbow joint is satisfactory.