Francel T J, Vander Kolk C A, Hoopes J E, Manson P N, Yaremchuk M J
Division of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.
Plast Reconstr Surg. 1992 Mar;89(3):478-87; discussion 488-9.
Seventy-two patients with Gustilo grade IIIB open tibial fractures were treated with free-tissue transfers. If successful free-tissue transfer for soft-tissue reconstruction is performed within 15 days of injury, the risk of major complications is 3.6 percent. Long-term retrospective follow-up (mean 42 months) revealed successful limb salvage in 93 percent, good aesthetic results in 80 percent, and patient satisfaction in 96 percent. However, 66 percent of patients exhibited significantly decreased range of motion of the ankle, 44 percent experienced swelling and edema requiring elastic support and activity modification, and 50 percent occasionally required an assistance device for ambulation. The long-term employment rate was 28 percent, and no patient returned to work after 2 years of unemployment. In contrast, 68 percent of amputees after lower extremity trauma over the same period returned to work within 2 years. Patients need to realize the disruptive nature of this injury on their family, job, and future.
72例Gustilo IIIB型开放性胫骨骨折患者接受了游离组织移植治疗。如果在受伤后15天内成功进行游离组织移植以重建软组织，主要并发症的风险为3.6%。长期回顾性随访（平均42个月）显示，93%的患者肢体挽救成功，80%的患者获得良好的美学效果，96%的患者对治疗满意。然而，66%的患者踝关节活动范围明显减小，44%的患者出现肿胀和水肿，需要弹力支持并调整活动，50%的患者偶尔需要辅助器械行走。长期就业率为28%，没有患者在失业2年后重返工作岗位。相比之下，同期下肢创伤后截肢患者中有68%在2年内重返工作岗位。患者需要认识到这种损伤对其家庭、工作和未来的破坏性。
