带蒂皮瓣转移联合外固定架治疗小腿开放性骨折伴软组织缺损

Luo Zhongchun, Lou Hua, Jiang Junwei, Song Chunlin, Gong Min, Wang Yongcai

Department of Orthopaedics, People's Hospital of Leshan, Leshan Sichuan, PR China.

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2008 Aug;22(8):956-8.

OBJECTIVE

To investigate the clinical results of treating leg open fracture with soft tissue defect by pedicle flap transfer in combination with external fixator.

METHODS

From May 2004 to June 2007, 12 cases of leg open fracture with soft tissue defect, 9 males and 3 females aged 18-75 years, were treated. Among them, 8 cases were caused by traffic accidents, 2 crush, 1 falling and 1 mechanical accident. According to the Gustilo Classification, there were 2 cases of type II, 5 of type IIIA and 5 of type IIIB. There were 2 cases of upper-tibia fracture, 3 of middle-tibia and 7 of middle-lower. The sizes of soft tissue defect ranged from 5 cm x 3 cm to 22 cm x 10 cm.The sizes of exposed bone ranged from 3 cm x 2 cm to 6 cm x 3 cm. The course of the disease was 1-12 hours. Fracture fixation was reached by external fixators or external fixators and limited internal fixation with Kirschner wire. The wounds with exposed tendons and bones were repaired by ipsilateral local rotation flap, sural neurocutaneous flap and saphenous nerve flap. The size of selected flap ranged from 5 cm x 4 cm to 18 cm x 12 cm. Granulation wounds were repaired by skin grafting or direct suture.

RESULTS

All patients were followed up for 6 months to 2 years. All patients survived, among whom 2 with the wound edge infection and 1 with the distal necrosis were cured by changing the dressing, 8 with pin hole infection were treated by taking out the external fixator, 1 with nonunion received fracture healing after bone graft in comminuted fracture of lower tibia, 2 suffered delayed union in middle-lower tibia fracture. The ROM of ankle in 3 cases was mildly poor with surpass-joint fixation, with plantar extension of 0-10 degrees and plantar flexion of 10-30 degrees, while the others had plantar extension of 10-20 degrees and plantar flexion of 30-50 degrees.

CONCLUSION

The method of pedicle flap transfer combined with external fixator is safe and effective for the leg open fracture with soft tissue defect.

目的

探讨带蒂皮瓣转移联合外固定架治疗小腿开放性骨折伴软组织缺损的临床效果。

方法

2004年5月至2007年6月，治疗12例小腿开放性骨折伴软组织缺损患者，男9例，女3例，年龄18 - 75岁。其中，8例由交通事故所致，2例为挤压伤，1例为坠落伤，1例为机械伤。根据Gustilo分类，Ⅱ型2例，ⅢA型5例，ⅢB型5例。胫骨上段骨折2例，中段骨折3例，中下段骨折7例。软组织缺损大小为5 cm×3 cm至22 cm×10 cm。外露骨大小为3 cm×2 cm至6 cm×3 cm。病程为1 - 12小时。采用外固定架或外固定架联合克氏针有限内固定进行骨折固定。对肌腱和骨外露的创面采用同侧局部旋转皮瓣、腓肠神经营养皮瓣及隐神经皮瓣修复。所选皮瓣大小为5 cm×4 cm至18 cm×12 cm。肉芽创面采用植皮或直接缝合修复。

结果

所有患者随访6个月至2年。所有患者均存活，其中2例伤口边缘感染、1例远端坏死经换药治愈；8例针孔感染经取出外固定架治疗；1例胫骨下段粉碎性骨折骨不连经植骨后骨折愈合；2例胫骨中下段骨折出现延迟愈合。3例踝关节活动度因跨关节固定轻度欠佳，跖屈0 - 10度，背伸10 - 30度，其余患者跖屈10 - 20度，背伸30 - 50度。