严重下肢创伤后病理畸形与修复

Pathologic deformity and repair of the severely traumatized lower extremity

目的 探讨下肢创伤后病理畸形与修复。方法 对332例严重下肢创伤后患者的病史、体征、x线检查等的分析以及对11种手术方法修复软组织、骨缺损等的评价。结果 主要病理畸形:①软组织缺损或骨缺损、骨髓炎;②大范围骨外露、骨坏死并创面感染;③贴骨瘢痕及慢性溃疡;④肌肉麻痹等。应用皮瓣修复创面284例均成功。骨瓣治疗骨不连、骨缺损均愈合。随访2～5年,下肢功能改善,无1例因病废而截肢。结论 根据下肢不同病理畸形,选择最佳修复方法,能获得良好效果。

Objective To investigate the pathologic deformity and repair methods of severely traumatized lower extremity. Methods The medical history , physical sign and X - ray film of 332 severely traumatized lower extremities were analysed and 11 surgical methods of repairing soft tissue and bone defect were studied. Results The main pathologic deformity ① soft tissue and bone defects, osteomyelitis. ② extensive skin and soft tissue defects with exposure of bone , osteonecrosis with wound infection. ③ scar covered bone and chronic ulcer.④) myoparalysis. We have succeeded in repairing 284 cases of soft tissue loss with skin flap grafting and 48 cases of bone ununion, bone defects with bone flap transfering. Follow - up for 2 to 5 years, the function of the lower extremity was improved . None of them was amputated for the pathologic deformity. Conclusion According to the different pathologic deformity of the traumatized lower extremity, selecting the preferable repair method can acquire good results.