外固定架联合胫后动脉穿支皮瓣修复胫骨远端骨折内固定术后骨及钢板外露

External Fixator Combined Posterior Tibial Artery Perforator Flap to Repair Distal Tibial Fractures after Bone and Plate Exposure

目的探讨胫骨骨折术后骨、钢板外露的治疗方法。方法 2012年以来,我院应用单臂外固定架联合胫后动脉穿支皮瓣修复胫骨骨折内固定术后骨及钢板外露17例。术前常规行创面分泌物细菌培养及药敏实验,根据药敏结果全身应用敏感抗生素治疗,根据创面情况11例给予彻底清创后行创面VSD负压冲洗引流术,持续冲洗引流9~10d,感染得到有效控制后,用单臂外固定架联合胫后动脉穿支皮瓣修复胫骨骨折内固定术后软组织感染缺损致骨及钢板外露。结果术后皮瓣全部成活,15例胫骨骨折愈合,2例胫骨骨不连,后期给予取髂骨植骨内固定或截骨延长术,骨折愈合,患肢功能恢复良好。结论单臂外固定架联合胫后动脉穿支皮瓣是修复胫骨骨折内固定术后软组织感染缺损致骨及钢板外露的有效方法。

Objective To explore the treatment methods of bone and plate exposure after operation of the tibial fracture. Methods Since 2012,seventeen patients of distal tibial fractures after bone and plate exposure,our application of single arm external fixator combined posterior tibial artery perforators flap to treatment. Preoperative routine bacterial culture and drug susceptibility test line wound secretion. According to the results of drug sensitive systemic application of sensitive antibiotic treatment. According to the wound,eleven patients were given the VSD wash of negative pressure drainage after debridement,vcontinuous washing drainage 7 ~ 9d. After the infection were under control,application of single arm external fixator combined posterior tibial artery perforators flap to treatment. Results Postoperative flaps all survived,15 patients with tibial fracture healing. Two patients with tibia bone nonunion,fracture healing after two-stage operation. All patients with postoperative function were good. Conclusion External fixator combined posterior tibial artery perforator flap is a effective method to repair distal tibial fractures after bone and plate exposure.