外固定架联合皮瓣移植治疗合并软组织缺损的开放性胫腓骨骨折

Treatment of open fractures of tibia and fibula with concurrent defect of soft tissues by external fixator and skin flap grafting

目的 探讨合并软组织缺损的开放性胫腓骨骨折的治疗方法。方法 对 2 8例合并软组织缺损的开放性胫腓骨折联合应用骨外固定架与皮瓣移植治疗 ,其中皮肤缺损面积最大 12cm× 7cm ,最小 5cm× 5cm ,骨缺损 8例。结果 随访 2 6例 ,时间 6～ 2 0个月。骨折骨性愈合时间平均为 2 0周 ,游离髂骨植骨骨性愈合时间 3 1周 ,无不愈合病例。皮瓣全部成活 ,无感染、坏死 ,外形及功能恢复满意。结论 单侧外固定支架与皮瓣移植联合修复小腿严重创伤是较理想的组合。一期清创、建立骨支架、修复血供 ,延迟一期修复创面及组织缺损较为合理。

Objective To study the methods for treatment of open fractures of tibia and fibula with concurrent defect of soft tissues. Methods 28 cases were treated by external fixator and skin flap grafting,and among them 8 cases were examined to have defect of bones.The largest skin defect area was 12 cm×7 cm and the smallest was 5 cm×5 cm. Results The average time for fractures to reset was 20 weeks.By means of bone free iliac grafting,the resting time was 31 weeks. No case of non union was found. Survival rate of flaps was 100% and all free of infections or necrosis,the appearance and functions of skin flap achieved satisfactory recovery. Conclusion A better treatment of serious shank injuries is to combine external fixator and skin flap grafting.The first stage of operation is to clean the wounds,put up bone supporting structure,reparation and restoration of blood circulation system.The next stage is the reparation of surface of the wounds and the defect of tissues.