吻合血管超长腓骨移植治疗胫骨严重粉碎性骨折

Treatment of severe tibia syntripsis by overlength fibular transplantation with vascular anastomosis

目的 报告２６ 例吻合血管的腓骨移植治疗胫骨粉碎性骨折及软组织损伤的临床经验。 方法 ２６ 例均为开放性骨折，属Ｈａｎｓｅｎ Ⅲ型骨折，其中多发伤１４ 例。合并胫前和（ 或）胫后动脉损伤１５ 例，合并胫后神经损伤６ 例，腓总神经损伤５ 例。２６ 例中，１６ 例Ⅰ期行吻合血管的超长腓骨或复合组织瓣移植，同时分别修复损伤的神经、血管及软组织，１０ 例延期修复。 结果 术后随访６ ～２４ 个月，２６ 例胫骨骨折均骨性愈合，修复的血管、神经及肢体功能恢复良好，无一例发生感染。 结论 吻合血管的超长腓骨移植Ⅰ期或延期治疗严重的胫骨开放性粉碎性骨折，可促进骨愈合，降低感染及截肢率。

Objective To report clinical experience of treatment of severe tibia syntripsis and soft tissue injury by fibular transplantation with vascular anastomosis in 26 cases. Methods Of 26 cases of open tibia fracture which was one of Hansen Ⅲ tibia fractures, 14 cases were with multiple injuries, 15 with anterior tibia artery and/or posterior tibia artery injury, 6 with posterior tibia nerve injuries and 5 with common peroneal nerve injuries and. Of 26 cases, 16 cases were treated primarily with fibular or compositus tissue flap transplantation with vascular anastomosis; injured nerves,blood vessels and soft tissues were restored. Ten cases accepted delayed treatment. Results The follow up for 6 to 24 months showed that all 26 cases with tibia fracture were cured. The repaired arteries, nerves, limbs and trunk returned to satisfactory function. None had infection. Conclusions Primary or delayed treatment of open tibia syntripsis by overlength fibular transplantation with vascular anastomosis can help fracture healing and decrease the rate of infection and amputation.