组织瓣移植联合骨延长技术分期修复烧创伤后下肢严重软组织与骨缺损

发布时间：2018-11-16 14:23

【摘要】：目的探讨组织瓣移植联合骨延长技术修复烧创伤后下肢严重软组织与骨缺损的临床效果。方法2010年1月—2015年12月,收治严重股骨或胫骨合并皮肤软组织缺损患者11例。男10例,女1例;年龄19~37岁,平均28岁。致伤原因:交通事故伤8例,高压电烧伤2例,CO中毒烧伤1例。伤后至该次入院时间为3~14 d,平均6.5 d。骨缺损长度8~18 cm,平均14 cm;皮肤软组织缺损范围13 cm×8 cm~25 cm×19 cm。一期彻底去除坏死组织和病变股骨或胫骨断端,组织瓣修复软组织缺损;二期采用Orthofix单边外固定延长架或Ilizarov环形外固定延长架修复骨缺损。结果术后1例修复术后2个月皮瓣下出现一窦道,经扩创、去除坏死股骨、抗生素骨水泥间隔物填充后愈合;其余患者切口均Ⅰ期愈合。骨延长期间,1例出现针道感染,经换药和加强护理后控制感染。患者截骨段延长8~18 cm,平均14 cm;停止延长后外固定支架继续保留4~12个月,平均6.5个月。患者骨缺损均修复,骨愈合时间为12~22个月,平均17个月。患者均获随访,随访时间8~24个月,平均15个月。患者治疗期间均未出现血管、神经损伤,术后未见骨髓炎、再骨折等并发症发生,下肢功能恢复较好。结论组织瓣移植联合骨延长技术修复烧创伤后下肢严重软组织与骨缺损可获较好疗效。
[Abstract]:Objective to investigate the clinical effect of tissue flap transplantation combined with bone lengthening technique in repairing severe soft tissue and bone defects of lower extremities after burn trauma. Methods from January 2010 to December 2015, 11 patients with severe femoral or tibia skin and soft tissue defects were treated. Male 10 cases, female 1 case, the age is 1937 years old, average 28 years old. The causes of injury were: 8 cases of traffic accident, 2 cases of high voltage burn and 1 case of CO poisoning burn. The time from injury to admission was 314 days, with an average of 6.5 days. Length of bone defect: 8 cm 脳 8 cm~25 cm 脳 19 cm., average: 14 cm;. Skin and soft tissue defect area: 13 cm 脳 8 cm~25 cm 脳 19 cm. The necrotic tissue and the damaged femur or tibia were completely removed in one stage and the soft tissue defects were repaired with tissue flap. The bone defects were repaired with Orthofix unilateral external fixator or Ilizarov ring external fixator in the second stage. Results one case had a sinus under the flap 2 months after repair, which was dilated, necrotic femur was removed, and the antibiotic bone cement septum was filled and healed. During bone lengthening, one case developed needle infection, which was controlled by changing medicine and strengthening nursing care. The osteotomy segment was prolonged for 8 ~ 18 cm, (mean 14 cm;) and the external fixation stent remained for 4 ~ 12 months (mean 6.5 months). All the bone defects were repaired, the healing time was 12 ~ 22 months (mean 17 months). All patients were followed up for 8 ~ 24 months (mean 15 months). No vascularization or nerve injury occurred during the treatment, no osteomyelitis, refracture and other complications occurred, and the lower extremity function recovered better. Conclusion the treatment of severe soft tissue and bone defect of lower extremities after burn injury with tissue flap transplantation combined with bone lengthening technique is effective.
【作者单位】：北京积水潭医院烧伤科;北京积水潭医院创伤骨科;
【分类号】：R687.3

【参考文献】