I期皮瓣或肌皮瓣移植在Ⅲ型Pilon骨折中的应用

Application of flap or musculocutaneous flap primary transplantation in Pilon fractures of typeⅢ

目的:探讨Ⅰ期皮瓣或肌皮瓣移植应用于Ⅲ型Pilon骨折的可行性。方法:Pilon骨折12例,男9例,女3例;年龄21～61岁,平均39.2岁。按照Rüedi和Allg觟wer分型,所有病例均为Ⅲ型;按开放性骨折Gustilo分型,Ⅲa型4例,Ⅲb型8例。常规骨折内固定前彻底清创后,内固定置入后常规再次放止血带彻底清创,特别是创缘要彻底清除失活组织。根据缺损面积大小常规行局部皮瓣,筋膜瓣及腓肠肌内侧头肌皮瓣转移修复术使创面彻底覆盖。结果:12例随访6～36个月,平均18个月,按照Mazur等制定的踝关节症状与功能评价标准进行评估,优6例,良3例,可2例,差1例。术后无皮瓣或肌皮瓣坏死和感染并发症发生,局部皮肤边缘有2例坏死,经换药后治愈,未行II期清创缝合术。结论:合理彻底的清创,特别是广泛彻底地清除失活软组织和被污染的游离骨块是I期闭合创面的前提条件,I期皮瓣或肌皮瓣移植应用于Ⅲ型Pilon骨折的软组织修复具有治疗周期短、踝关节功能恢复佳等优点。

Objective ：To discuss the value of one stage flap or musculocutaneous flap to repair the soft tissue defect in Pilon fracture. Methods ：Twelve cases with Pilon fracture included 9 male and 3 female with an average age of 39.2 years ranging from 21 to 61 years. All fractures were type Ⅲ according to Ruedi and Allgower. According to Gustilo sysytem, Ⅲa were in 4 cases, Ⅲ b were in 8. A thorough debridement was made before internal fixation. After the internal fixation implanted, the tourniquet was released and a thorough debridement was made again. Be sure of the wound cleansed of all dead and foreign material,the wound was covered with local flap ,musculocutaneous or gastrocnemius flaps depending on the size and localization of wound. Results： All the patients were followed up from 6 to 36 months, 18 months in average. The function of ankle was assessed according Mazur system. The results were excellent in 6 cases,good in 3,fair in 2 and poor in 1. No infection or necrosis happened on flaps. Although necrosis happened in the wound margin of two patients, they all healled up by conservative methods. Conclusion： Primary closure of soft tissue defect in Pilon fracture using flap or musculoeutaneous flap have ability to shorten the treating time and recover the function of ankle. It is important to have a thorough debridement of the dead tissue and free bone.