肌皮瓣转移联合交锁髓内钉治疗胫前软组织坏死合并胫腓骨骨折

Fibula muscle flap transfer combined with interlocking intramedullary nail in the treatment of anterior tibial soft tissue necrosis combined with fracture of tibia and fibula

目的探讨肌皮瓣转移联合交锁髓内钉治疗胫前软组织坏死合并胫腓骨骨折的临床疗效。方法 2010年12月～2011年12月本院骨科共收治胫腓骨骨折患者38例,对所有患者行肌皮瓣转移联合交锁髓内钉术治疗。结果经手术治疗并随访1年后,所有患者骨折均得到康复,愈合时间4～8个月;骨折延迟愈合2例,愈合时间均为8个月,皮瓣术后Ⅰ期愈合33例,术后出现伤口感染3例,经换药4～6周后得到改善;恢复1年后,所有患者皮瓣外观理想,踝关节活动自如,走、跑、跳均无受到影响,均未出现皮肤坏死及感染。结论肌皮瓣转移联合交锁髓内钉治疗胫前软组织坏死合并胫腓骨骨折,可以通过一次治疗便能痊愈,操作相对简单,具有疗程短等优势,同时可提高局部抗感染能力,进而加快骨折部位的愈合速度,患者经手术后生活质量基本不受影响,可以在临床上加以推广。

Objective To investigate the clinical curative effect of fibula muscle flap transfer combined with interlock ing intramedullary nail in the treatment of anterior tibial soft tissue necrosis combined with fracture of tibia and fibula.Methods 38 cases were treated in our hospital department of orthopedics tibial fractures from December 2010 to De cember 2011,for the all patients with muscle flap transfer combined to surgery in the treatment of locking in tramedullary nail.Results 38 patients were treated by operation,and 1 years of follow-up,all of the fractures were healed,the healing time was from 4 months to 8 months;delayed fracture healing in 2 cases for both of 8 months,33 patients with stage I healing after flap operation,postoperative wound infection in 3 cases,the condition was improved after 4-6 weeks of dressing;after 1 years,all patients ’appearance of the flaps were ideal,ankle joint activities freely,walk,run,jump were not affected,there was no skin necrosis and infection.Conclusion Fibula muscle flap transfer combined with interlocking intramedullary nail in the treatment of anterior tibial soft tissue necrosis combined with fracture of tibia and fibula,which can be cured by one treatment,the operation is relatively simple,with short course and other advantages,and can improve the local resistance to infection,so as to accelerate the fracture healing rate after op eration,the quality of life in patients with basic not affected,can be promoted in clinical practice.