55例高能量肢体伤的Ⅰ期修复重建

One stage reconstruction of limb injuries caused by high energy in 55 patients

目的总结Ⅰ期修复重建高能量肢体损伤的经验体会，就相关问题进行探讨。方法自2001年1月至2005年7月，对55例高能量肢体损伤实施Ⅰ期修复重建，本组患者均存在伤部软组织广泛挫灭、严重的开放性骨折或肢体已接近毁损，包括Gustilo Ⅲ C型开放骨折16例，肢体损伤严重度评分（MESS）（6．25±2．53）分。全部进行游离或带蒂组织瓣移植，同时固定骨折，修复神经血管或进行肢体功能重建。结果全部保肢成功，住院天数12～63d，平均24d，移植组织瓣全部成活。随访时间12～50个月，平均23个月。骨愈合率高，感染率低，肢体功能满意。结论Ⅰ期手术组织结构容易辨明，供、受区血管搭配及手术设计容易，治疗周期短，功能恢复好。吻合血管的组织瓣可主动改善局部循环，降低骨感染，利于骨愈合，使骨折坚强固定甚至早期植骨成为可能。

Objective To report the clinical results of one stage reconstruction of high-energyinjured limbs. Methods From January 2001 to July 2006, one stage reconstruction was done on 55 patients suffered from massive limb trauma, severe open fractures or spoiled limbs caused by high energy. There included 16 patients with Gustilo Type-lll C fractures, with mangled extremity severity score （MESS） of （6.25 ±2.53） points. All patients were treated with transplantation of free flaps or pedicle skin flaps, fracture fixation, nerve reconstruction or functional reconstruction. Results All limbs were saved and all flaps were transplanted successfully, without protracted course to obtain soft tissue coverage. The hospitalization was mean 24 days （ 12-63 days） and follow-up ranged from 12 months to 50 months （averaged 23 months）. Complications including wound infection, bone nonunion, necrosis and morbidity were significantly less likely to appear than conventional ways and the ultimate functional results of the saved limbs were at least better than that of artificial ones. Conclusions In comparison with traditional methods, one stage reconstruction of severe high energy-injured limbs has advantages of easier justification of tissue structure, better match of donor and recipient blood vessels, easier operation design, shorter hospitalization and better functional recovery. Definitive wound closure with vascularised tissue transfer can facilitate local blood supply, decrease bone infection and hence promote bone healing.