前臂毁损伤的保肢治疗

Limb-salvage treatment in forearm smashed wound

目的 探讨前臂毁损伤保肢的先决条件及治疗方法.方法 2009年3月-2015年9月,在正确判断伤情后,对有保肢条件的18例前臂毁损伤,对血管、神经、骨骼及软组织进行清创、探查修复及移植重建血供与缺损,骨骼利用锁定钢板及外固定支架固定,对前臂软组织缺损利用皮瓣修复及持续负压封闭引流（vacuum sealing drainage,VSD）技术Ⅱ期创面处理,选择性保肢.结果 除2例保肢失败,16例前臂毁损伤成功保肢,创面均Ⅱ期处理,5例骨不连,2例骨髓炎,经多次清创、植骨及功能重建后恢复部分功能.16例获得随访,时间为6个月-5年,前臂及手外形与功能改善较满意,痛、深触觉正常存在.结论 正确判断伤情,对前臂神经连续性存在、血管及软组织碾轧伤可采用显微外科技术修复,应尽力保肢,Ⅱ期行功能重建,以挽救手功能.

Objective To investigate prerequisites and methods of limb-salvage treatment in forearm smashed wound. Methods There were 15 cases with forearm smashed wound, which were selected and treated with limb-salvage operation according to the injury condition.After debridement and exploration, vessels and nerves defects were repaired with transplantation, bone fractures were fixed with locking plates or external fixators, and vacuum sealing drainage techniques were applied in soft tissue defects for promotion of wound healing. Results Among the 15 cases, 2 cases failed in limb salvage and 13 cases were successful, among which all the wounds needed second-stage treatment. 5 cases had osteal nonunion and 2 cases had osteomyelitis, the patients＇ forearm function recovered partially after they had received many procedures of debridement, bone-graft and functional reconstruction. Postoperative follow-up was carried out for 6 months to 5 years in 13 cases. The appearance and function of the forearms and hands were satisfactory, pain sensation and deep touch sensation existed. Conclusion The nerves defects, crush-injured vessels and soft tissue could be repaired with microsurgery techniques, so limb-salvage procedures should be taken in forearm smashed wound with correct assessment of the injury conditions. The scond-stage functional reconstruction operations are needed in order to save the hand functions.