短缩再植结合肢体延长术治疗小腿中下段严重离断伤

发布时间：2018-11-11 10:49

【摘要】：目的探讨短缩再植结合肢体延长技术治疗小腿中下段严重离断伤的临床疗效和技术要点。方法 2009年4月—2016年5月,采用一期短缩再植二期延长技术治疗小腿中下段离断伤12例。其中男9例,女3例;年龄16~32岁,平均28岁。致伤原因:交通事故伤4例,重物砸伤6例,机器挤压伤2例。受伤至就诊时间为30 min~6 h,平均3 h 12 min。其中右小腿中下段完全离断6例,左小腿中下段不全离断4例,左踝关节平面完全离断2例。肢体短缩4.0~12.5 cm,平均7.3 cm;再植术后1.5~8.0个月行肢体延长术,延长时间1.7~5.3个月,平均3.1个月。结果 12例短缩再植后再延长均达到双下肢等长,术后延长段骨矿化良好,骨断端和延长骨段均达骨性愈合,愈合时间7~16个月,平均11.3个月。所有患者均获随访,随访时间6个月~5年,平均2年5个月。膝关节活动范围:过伸0~5°,平均3°;屈曲110~140°,平均120°。除2例踝关节融合外,其余患者跖屈15~45°,平均26°;背屈10~25°,平均15°。足底感觉恢复至S_3+4例,S_3 6例,S_2 2例。末次随访时根据Kofoed功能评定标准评价,获优7例,良3例,可2例。结论通过短缩再植结合肢体延长技术治疗小腿中下段严重离断伤,扩大了下肢离断再植适应证,降低了再植难度,治疗更简便有效。
[Abstract]:Objective to investigate the clinical effect and technical points of short replantation combined with limb lengthening in treating severe broken lower leg injury. Methods from April 2009 to May 2016, 12 patients with middle and lower leg amputation were treated with one stage shortening replantation and two stage lengthening technique. Among them, 9 cases were male and 3 cases were female, the age was 16 ~ 32 years old with an average age of 28 years. The causes of injury were traffic accident in 4 cases, heavy object injury in 6 cases and mechanical crush injury in 2 cases. The time from injury to consultation was 30 min~6 / h, with an average of 3 h / 12 min. Among them, 6 cases were completely amputated in the middle and lower segment of the right leg, 4 cases were incomplete amputation of the middle and lower segment of the left leg, and 2 cases had complete dissection of the left ankle plane. Limb lengthening was performed at an average of 1.5 ~ 8.0 months after replantation of 4.0m cm, (12.5 cm,), and the lengthening time was 1.710 months (mean 3.1months). Results all the 12 cases were lengthened to the same length of lower extremity after replantation. The bone mineralization of the lengthened segment was good. The bone healing time was 7 ~ 16 months (mean 11.3 months). All patients were followed up for 6 months to 5 years with an average of 2 years and 5 months. The range of knee joint motion was 5 掳(mean 3 掳) and 110 掳140 掳(mean 120 掳). Except for the fusion of ankle joint in 2 cases, the flexion of metatarsus was 1545 掳(mean 26 掳), and that of dorsal flexion was 1025 掳(mean 15 掳). The plantar sensation recovered to S _ S in 34 cases, S _ S in 36 cases, S _ 2 in 22 cases. According to Kofoed functional evaluation criteria, 7 cases were excellent, 3 cases were good and 2 cases were fair at the last follow-up. Conclusion the technique of shortening replantation combined with limb lengthening is more convenient and effective for the treatment of severe lower leg amputated injury. The indication of replantation of lower extremity is enlarged, the difficulty of replantation is reduced, and the treatment is more simple and effective.
【作者单位】：郑州仁济医院创伤骨科;
【基金】：郑州市管城区科技计划项目(GK201724)~~
【分类号】：R658.3

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