胫骨皮瓣修复小腿感染性骨皮缺损的应用VIP免费

胫骨皮瓣修复小腿感染性骨皮缺损的应用贾红伟程春生吕松峰赵作恭单海民杜志军汤金城任飞【摘要】目的探讨胫骨皮瓣在修复小腿感染性骨皮缺损中的应用及效果。方法2000年2月～2005年3月,收治因外伤致小腿开放性骨折68例。男47例,女21例,年龄8～59岁。按Gustilo分型均为�型。其中4例一期行胫骨皮瓣游离移植术,64例急诊术后形成小腿感染性骨皮缺损。胫骨缺损长度4～18cm,皮肤缺损范围8cm×3cm～22cm×11cm,创面均有脓性渗出物。经中药薰洗湿敷后,利用胫骨皮瓣通过游离移植、交腿移位和同侧移位方法,重建患肢胫骨支架连续性并修复创面。切取皮瓣范围9cm×4cm～25cm×12cm,骨瓣长度为6～21cm。结果术后1例因血管危象经探查再吻合血管失败,改用腓骨皮瓣修复。1例切取胫骨皮瓣21cm,因近端为延长血管蒂,骨膜与骨瓣剥离过长,随访6个月近端仍延迟愈合;余患者3～5个月骨瓣与受区胫骨愈合。68例均获随访6个月～5年,43例随访2年以上者均能负重行走,步态无明显异常,能从事原工作。结论在充分抗感染的基础上,根据患肢具体情况采用胫骨皮瓣游离移植、交腿移位和同侧移位一期重建胫骨支架连续性及修复皮肤缺损创面,适用于小腿多种类型骨皮缺损创面,成功率高,能保留患肢,为功能恢复创造条件。【关键词】骨皮缺损胫骨皮瓣修复小腿中图分类号:R622R658.3文献标识码:ACLINICALAPPLICATIONOFTIBIALBONE-SKINFLAPSINTREATEMENTOFINFECTIVEBONE-SKINDE-FECTSOFLEG�JIAHongwei,CHENGChunsheng,LVSongfeng,etal.LuoyangOrthopedic2TraumatologicalHospi2talandInstituteofHenanProvince,LuoyangHenan,471002,P.R.ChinaCorrespondingauthor:JIAHongwei,E2mail:lyduwei@126.com【Abstract】ObjectivesToinvestigatetheclinicaltherapeuticeffectoftibialbone2skinflapsintherepairofin2fectivebone2skindefectsoftheleg.MethodsBetweenFebruary2000andMarch2005,68casesofleginfectivewoundswithtibialboneandskindefectsweretreated:4casesusingfreegrafting,64casesusingcross2legoripsilateraltranspo2sitiongraftingoftibialbone2skinflapssothatthetibialsupportcontinuityoftheaffectedlegcouldbereconstructedandthewoundcouldbecoveredatonestage.Theskinflaparearangedfrom9cm×4cmto25cm×12cmandtheboneflaplengthrangedfrom6cmto21cm.ResultsTheflapswerecompletelysurvivedin67ofthe68casesexcept1casewhichwasrepairedbyfibularbone2skinflapsbecauseofthefailedblood2vesselanastomosis;theboneflapswerehealedin66cases,except1casewhichhaddelayedunionoftheproximalendthrough62monthfollow2upbecausetibialboneflapwaslengthened,leadingtolongsofttissuestrippingoftheproximalend.Allthe68patientswerefollowedup6monthsto5years.Thelegfunctionandcontourweresatisfactory2yearsafteroperation.Thosepatientsfollowedupmorethan2yearsshowednormalweightloadingwalkingwithoutobviouslyabnormalgait,andcanengagedinoriginalwork.ConclusionOnthebasisofsufficientanti2infection,theone2stagereconstructionoftibialsupportcontinuityandthecoveringofwoundbythethreemethodsaresuitableformanytypesoflegboneandskindefects,haveagreatappli2cationvalueandhighsuccessfulrateandcanretaintheaffectedlimbandcreatetheconditionsforthefunctionalrecov2ery.【Keywords】Bone2skindefectTibialbone2skinflapRepairLeg随着工业及交通运输业的日益发展,各种高能量暴力导致小腿严重损伤的几率大幅增加。由于小腿前内侧软组织少,缺乏对胫骨的保护,易导致小腿感染性骨皮缺损,处理困难。回顾总结我院自2000年2月～2005年3月,应用胫骨皮瓣修复小腿感染性骨皮缺损且具有完整资料的68例患者。报告如下。作者单位:洛阳正骨医院正骨研究所(河南洛阳,471002)通讯作者:贾红伟,副主任医师,研究方向:手外科、显微外科,E2mail:lyduwei@126.com1临床资料1.1一般资料本组男47例,女21例。年龄8～59岁,中位年龄为36岁。受伤原因:车祸伤43例,砸伤13例,机器伤7例,高处坠落伤5例。胫骨受伤部位:左侧43例,中上段...