剑苤志2010年第12卷第4期JTraumaSurg，2010，Vo1．12，N0．4·论著·文章编号：1009—4237(2010)04—0297—04·297·小腿局部组织感染性缺损的临床分型及治疗选择张群，陶笙，唐佩福，郭义柱，梁向党，梁雨田，陈华【摘要】目的探讨小腿局部组织感染性缺损的临床分型与治疗选择。方法2004年2月2009年12月我院收治了386例小腿局部组织感染性缺损的病例，根据组织缺损的程度及范围将其分为Ⅲ型二度。单纯皮肤软组织缺损与感染为I型；同时伴有胫骨骨折及(或)肌腱、神经断裂为Ⅱ型；同时伴有胫骨缺损为Ⅲ型。胫骨及(或)肌腱、血管、神经暴露的面积<5cm×5cm为一度；>5cm×5cm为二度。I、Ⅱ型一度：负压封闭引流(VSD)技术加植皮术治疗；I、Ⅱ型二度：VSD加皮瓣修复技术治疗；Ⅲ型：骨搬移技术治疗。结果全组病例均获临床治愈，其中I型二度69例，7例皮瓣边缘坏死，4例感染复发形成窦道，经换药后治愈；Ⅱ型一度71例，15例创面肉芽生长慢，改用皮瓣转移后治愈；Ⅱ型二度54例，9例感染复发窦道形成，3例经换药治疗后痊愈，6例感染不能控制，经骨搬移治疗后痊愈；Ⅲ型97例，3例局部骨感染复发，经再次清创截骨延长后治愈，3例骨延长区骨痂形成不全，经植骨后治愈。结论小腿局部组织感染性缺损的分型有利于指导临床选择合理有效的治疗方法。【关键词】小腿；感染；组织缺损；负压封闭弓l流；皮瓣；骨搬移【中图分类号】R681．8【文献标识码】AClinicalclassificationofinfectioussofttissuedefectsinleganditstreatmentZHANGQun，TAOSheng，TANGPei-fu，GUOYi—zhu，LIANGXiang—dⅡ，，LIANGYu—tian，CHENHua(DepartmentofOrthopaedics，PLAGeneralHospital，Beijing100853，China)【Abstract】ObjectiveToexploretheclassificationandtreatmentofinfectioussofttissuedefectsinleg．Meth-odsTotally386caseswithinfectioussofttissuedefectsinlegwereadmittedintoourhospitalfromFeb．2004toDec．2009．Accordingtotheextentofsofttissuedefectsanditsarea，theseinjurieswereclassifiedwiththreetypesinwhichthereweretwogroups，group1withbone，vascularandnerveexposureareaoflessthan25em，andgroup2withbone。vascularandnerveexposureareaofmorethan25cm．TypeIpresentedwithsimpleinfectioussofttissuedefect；typeIIpresentedwithinfectioussofttissuedefectcombinedwithtibialfracture，tendonandnervedisruption；typellIpresentedwithinfectioussofttissuedefectcombinedwithbonedefects．Thepatientsingroup1oftypeIandtypeI／weregivenvacuumsealingdrainageandfreeskingrafts．Thoseingroup2oftypeIandtypeI1weregivenskinflapsrepair．ThosewithtypemwereVenbonetransporttreatments．ResultsAllthepatientswerecuredsuccessfully．Sevenof69caseswhowereingroup2oftypeI，hadrimnecrosisofskinflap，4caseshadrecurrentinfectionswithsinusformationandrecoveredbyeverydaydressings；Fifteencasesof71caseswhowereingroup1oftypeII，werecuredwithskinflapstreatment；Nineof54casesingroup2oftypeⅡ，hadrecur—rentinfectionswithsinusformation，3ofthe9patientswerecuredbyeverydaydressing，and6easesbybonetrans—porttreatmentbecauseofsevereinfections；among97casesoftypeⅢ，3easeswithrecurrentinfectionsafterthefirstbonetransporttreatmentweresuccessfullytreatedbydebridingosteotomizedbone，3caseswhometwithbonecallusformationinbonelengtheningareas，hadbonehealingafterautogenousbonetransplant．ConclusionTheclassificationofinfectioussofttissuedefectsinleghelpstochooseeffectivetreatmentmethodsinclinic．【Keywords】leg；infections；tissuedefect；vacuumsealingdrainage；skinflap；bonetransport小腿严重创伤后，皮肤、软组织及胫骨缺损十分常见，大多又同时合并感染，在治疗上比较棘手。自2004年2月～2009年12月，我院根据组织缺损的程度及范围，将小腿局部组织感染性缺损分为Ⅲ型二度，分别应用负压封闭引流(VSD)技术、皮瓣移...
