手术治疗胫腓骨骨折术后骨外露的疗效探讨

Effect of Reoperation for Bone Exposure after Internal Fixation for Tibiofibular Fractures

目的 探讨手术处理胫腓骨骨折术后骨外露的疗效。方法 21例骨外露患者,其中7例单纯皮肤坏死并软组织感染,予清创及筋膜皮瓣转移处理;皮肤感染、坏死并骨髓炎但无明显死骨及死腔者9例,行彻底清创后,骨面钻多个小孔,予筋膜皮瓣转移,闭式冲洗引流;有明显骨质破坏的骨髓炎患者5例,伴内固定物松动,螺丝钉腔感染明显,拆除内固定,改外固定支架,行病灶清除,带神经血管的小腿内、外侧筋膜皮瓣及骨膜转移,闭式冲洗引流。结果 2例转移皮瓣边缘部分坏死,经换药后愈合,其余皮瓣均成活。18例获随访,平均10.5（6-12）个月,原有骨坏死的骨髓炎患者骨折均愈合,平均愈合时间5.3（3.5-7）个月。结论 再次清创、筋膜皮瓣转移术是治疗胫腓骨骨折术后骨外露的有效措施,对骨髓炎患者应行闭式冲洗引流。

Objective To discuss the therapeutic effect of reoperation for bone exposure after internal fixation for tibiofibular fracture. Methods 21 cases underwent reoperation for bone exposure after operation of tibiofibular fracture were analyzed retrospectively. Debridement and fascia flap transposition was performed in 7 cases of simple skin and soft tissue infection. Bone perforation, fascia flap transpostion and closed lavaging drainage was used in 9 cases of skin infection and osteomyelitis without sequestrum. And in the 5 cases with obvious sequestrum, the internal fixators were changed to external fixators in addition to the procedures mentioned above. Results Necrosis was occurred in the margined parts in 2 flaps, and the others all survived. In the 18 cases who followed up for 6 to 12 months,all osteomyelitis with sequestrum healed in 5.3 months averagely. Conclusion Re-debridement, fascia flap transposition is an effective method for bone exposure after internal fixation for tibiofibular fracture. And closed lavaging drainage is recommended to osteomyelitic patients.