外固定架结合显微外科修复伴血管损伤的严重下肢开放性骨折

External fixator combined with microsurgery for repairing open fracture of severe lower limb associated with injury of blood vessel

目的探讨对伴血管损伤的严重下肢开放性骨折采用外固定架结合显微外科修复治疗效果。方法对26例伴有血管损伤的严重下肢开放骨折治疗的临床资料进行回顾性分析。结果26例中随访25例，时间为6～36个月。术后2例发生动静脉血管危象；1例因皮肤坏死行外固定架调整，创面新鲜后行游离植皮术；3例骨缺损者在伤口愈合后Ⅱ期行腓骨游离移植，骨折全部愈合；5例因软组织坏死、缺损出现继发性骨髓炎，行游离股前外侧皮瓣移植后全部愈合，且无骨髓炎复发。骨折愈合时间为6～10个月，平均时间为8．9个月，所有肢体血运正常，血管通畅良好，组织瓣全部成活，质地与色泽较好。关节功能恢复较满意，按HSS膝关节评定标准：良6例（24％），中17例（68％），差2例（8％）。结论合并血管损伤的下肢严重开放性骨折危及肢体的存活，影响术后功能，治疗关键在于快速建立循环、有效覆盖创面和骨折端的可靠固定。应用外固定架快速、有效、可靠的固定各型骨折，结合显微外科技术修复，可以显著提高临床疗效。

Objective To discuss the effect of external fixator and microsurgery on repairing the open fracture of severe lower limb associated with injury of blood vessel. Methods A tatal of 26 cases of open fracture of lower limb with injury of blood vessel were analyzed retrospectively. Results In these 26 cases ,25 cases were followed up for 6 to 36 months. Aarteriovenous articulo after operation occurred in 2 cases ; cutaneous necrosis occurred in 1 case, which was adjusted with external fixator and taken free skingrafting when the wound surface was fresh ;free fibula transplantation after the wound healing was applied in 3 cases of bone defect, and all these bone fracture were healed ; soft tissue necrosis, defect, and secondary osteomyelitis occurred in 5 cases, all of which healed with free anterolateral thigh flap transplantation, and no osteomyelitis recurred. The healing time of fracture was 6 to 10 months （ mean 8.9 months ）. All circulation of the limbs was normal with unobstructed blood vessel ; all flaps were survived with good texture and colour;the shape and function of the survived limbs was good in 6 cases, 17 cases fair,2 cases poor. Conclusion Open fracture of severe lower limb with injury of blood vessel endangers the surviving of the limb,influences the postoperational function. The key lies in the rapid establishment of circulation, effective coverage of the wound surface, reliable fixation of the fracture. The treatment of external fixator combined with microsurgical technique cure various types of fractures rapidly, effectively, reliably and therefore can enhance the therapeutic effect significantly.