部分开放式组织瓣移植术治疗开放性胫骨骨感染

The treatment of open fracture and infection of tibia by grafting the musculocutaneous flap with uncovered in the special region

目的 探讨应用部分开放式组织瓣移植的方法治疗胫骨骨感染骨坏死的临床治疗价值.方法 伴不同感染程度的开放性胫骨缺损、骨坏死28例,于伤后3～8周行部分开放式的组织瓣移植修复术,并对其病程转归及治疗结果进行临床总结.胫骨上段6例,胫骨中下段21例,胫骨全长1例;单纯骨外露坏死5例,开放性骨感染骨缺损23例.应用局部带蒂岛状皮瓣2例,26例应用吻合血管的游离组织瓣移植.其中游离股前外侧（肌）皮瓣21例,髂骨皮瓣5例,腓骨瓣组合股前外侧（肌）皮瓣2例.结果 组织瓣全部成活,成活率达100%.移植骨瓣于术后3～6个月有骨痂形成包裹,坏死骨在6个月左右被大部分吸收替代,2例发生深部组织感染,经反复清创并开放创面后愈合.残留创面在术后3～6周闭合22例,术后3～6个月闭合6例.术后21例获得随访3个月到1.5年,疗效满意.与闭合式组织瓣移植术比较,其组织瓣切取面积小、深部组织感染几率小、有利于患者心理及体质恢复、缩短治疗周期.结论 部分开放式组织瓣移植术是治疗胫骨开放性骨坏死骨感染的理想方法.

Objective To study the clinical value of grafting the musculocutaneous flap with uncovered in the special region to treat the open fracture and infection of tibia. Methods Twenty-eight patients including 19 males and 9 females with ankle and leg tissue defect were applied to graft the musculocutaneous flap with uncovered in the special region from July 2007 to January 2010. The tissue defeat in proximal part of the tibia were 6 cases, and 21 cases in middle and distal part, 1 case almost in whole part of the tibia. The bone occurred a defeat and infection in 23 cases, the bone necrosis occurred in 5 cases. The patients treated with iliac bone flap were 5 cases, anterolateral thigh flap were 21 cases, anterolateral thigh flap combined with fibula flap were 2 cases, the flap were transplanted by anastomosis in 26 cases. Results The tissue grafting were all survival and the survival rate were 100%. The callus formation were appear after operation from 3 to 6 months, and necrosis bone tissue almost were abstracted about 6 months. The wound were primary closure and not happened infection in 26 cases, the wound appeared infection under deep tissue in 2 cased,but being cured after 6 months by operation. The 21 patients were followed up from 3 months to one and helf year. The long-term was satisfaction and the donor area was perfect. Compared with closed graft, its area of the flap was small and need spend little time to treat the repair the defeat, and harness to recover the healthy of body and mind, also decrease the chance of infection in deep tissue. Conclusion It is demonstrated that grafting the tissue flap with uncovered in the special region is an ideal approach to treat the open fracture and infection of tibia.