摘要
目的:评估ⅢC型胫骨骨折的不同治疗方法及其疗效。方法:采用组织瓣移植结合外固定架技术治疗GustiloⅢC型胫骨骨折37例。其中采用隐神经营养血管皮瓣10例,腓肠神经营养血管皮瓣18例,腓肠肌瓣9例;半环架17例、单边架9例、组合架11例。于16侧成人下肢标本上模拟各种皮瓣切取、转位手术操作。结果:37例组织瓣全部存活。35例骨折愈合,2例骨折不愈合;平均骨愈合时间半环架为5.5月,单边外固定架9.2月,组合式外固定架7.8月。解剖发现隐神经和腓肠神经营养血管皮瓣可以覆盖小腿的绝大部分部位缺损。结论:皮神经营养血管皮瓣可以很大程度代替传统皮瓣或游离皮瓣修复IIIC型胫骨骨折的软组织缺损。不同外固定架运用都可以有满意的疗效,但对复杂或粉碎骨折三维外固定架的固定效果更为可靠。
Objective： To evaluate the therapeutic regimens and effect of Gustilo ⅢC fracture of tibia. Methods： Thirty-seven Gustilo ⅢC fracture of tibia were treated by tissue flaps combined external fixation,including 10 skin flaps with saphenens nerve and nutrient vessels, 18 with sural nerve and nutrient vessels,9 gastrocnemius muscular flaps, 17 semicircular fixations,9 unilateral fixations, 11 assembled fixations. The operative procedure about obtaining various kinds of skin flaps and transposition were simulated and performed on the lower extremities in 16 cadavers.Results：All 37 tissue flaps was survival, thirty - five fractures of tibia were healed except two cases, and the average bone healing time was 5.5 months for those tructures fixed by semicircular fixation,9.2 months for unilateral fixation and 7.8 months for assembly fixation. The anatomy study showed that saphenous neurocutaneous vascular flaps and sural neurocutaneous vascular flaps could cover most of leg defect. Conclusions： The neurocutaneous vascular flaps could replace traditional flaps or free skin flaps in the treatment of soft tissue defects because of Gustilo ⅢC fracture of tibia. Various kinds of external fixation in this study work effectively, while three dimensional fixation is mere effective for those complex or comminuted fractures.
出处
《解剖与临床》
2007年第1期31-34,共4页
Anatomy and Clinics
