骨折术后钢板外露的综合治疗

Treatment of the Wounds with Nickelclad Exposure after Operation of Fracture

目的:介绍骨折术后钢板外露材料的处理及创面的修复。方法:回顾2000年1月至2011年6月275例钢板外露的患者,综合考虑四肢创面缺损的大小、感染、周围软组织情况,创面经过换药或者扩创,未感染或者感染得到控制的创面给予保留钢板,感染创面拆除钢板改用外固定支架固定,创面用局部旋转皮瓣、帯蒂转移或者游离皮瓣修复。结果:275例中有10例截肢。总共保留钢板164例,101例拆除钢板改用外固定支架。保留钢板的患者中有14例并发骨髓炎,经过1～4次扩创,冲洗引流,创面愈合;5例骨不愈合,经过植骨治疗,骨折愈合。改用外固定支架的患者,3例并发骨髓炎,创面扩创引流后愈合;2例骨不愈合,游离植骨及骨瓣治疗后愈合。创面修复中,局部转移皮瓣108例,有9例局部皮瓣术后部分坏死,经换药后愈合;42例岛状皮瓣,1例出现坏死,改用游离皮瓣创面愈合;125例游离组织瓣,2例游离髂骨瓣出现静脉危象,探查后皮瓣成活,1例游离股前外侧皮瓣因感染出现坏死。结论:钢板外露只要处理正确,部分钢板可以保留,通过皮瓣技术,创面能够得到较好修复。

Objective： To introduce the treatment of materials and the repairing of wounds for plate exposure after fracture surgery. Methods ： The data of 275 cases with nickelclad exposure were reviewed from January 2000 to June 2011. The size of de- fect in the limb wounds, infection and the condition of surrounding soft tissues were comprehensively considered. Wound were treated with dressing change or wound debridement. The plate was kept if the wound was not infected or the infection was con- troled. The plate was removed and switched to external fixation with fixed support if infection was occurred, local rotation flaps, pedicle transfer flap, and free flap were used to repaire the wounds. Results： In 275 cases, 10 cases were performed limb ampu- tation, 164 cases were kept plates, 101 cases were removed 1 plates. In patients who reserved plates, lg cases were complicated by osteomyelitis, and the wounds were closed up by 1 to 4 times debridement, irrigation and drainage. Five cases were nonunion, and the fractures were healed by bone grafting. In patients who used external fixation, 3 cases were complicated by osteomyehtis, and the wounds were closed up by irrigation and drainage. Two cases were nonunion, and the fractures were healed with free bone grafts and bone flap treatment. For the repairing of wounds, 108 cases were performed local rotation flaps, of which, 9 cases had part necrosis and the wounds were healed by dressing change. In 42 cases with island flaps, 1 case had necrosis and the wound was closed up by free flap. In 125 cases with free tissue flaps, 2 cases had venous crisis and the flaps survived after exploration, and 1 case had necrosis in free anterolateral femoral flap because of infection. Conclusion ： For wounds with nickelclad exposure, part of the plates can be reserved with correct treatment and the wounds can get a better repair by the flap techniques.