高能量损伤致下肢严重开放性毁损伤保肢治疗体会

Experience of comprehensive limb salvage treatment for serious composite tissue injury of lower extremity

目的 通过对下肢严重复合组织损伤的保肢诊疗的回顾性总结,探讨救治并进一步保全肢体和功能康复的方法.方法 总结近5年来收治的45例47肢下肢严重复合组织损伤的病例,均在伤后2~8 h内给予急诊手术,根据情况行内固定或外固定重建骨的支架,吻合损伤的血管和神经,VSD覆盖创面,再行Ⅰ期或Ⅱ期修复创面,术后给予综合治疗.结果 1例因组织热缺血时间长,术后肌肉大量坏死伴感染致肾功能衰竭而截肢,其余患肢皆保全,并能下地行走,术后功能评价满意.结论 正确的术前预判、合理的手术处理和术后的综合治疗,可有效挽救严重复合组织伤后濒临截肢的下肢肢体,降低致残率.

Objective To retrospectively summarize the limb salvage treatment for serious composite tissue injury of lower extremity and discuss the advanced methods for limb salvage and functional rehabilitation. Methods Summarize the clinical data of 45 patients （47 limbs） with serious composite tissue injury in the past 5 years. All of these patients were treated with emergency operation within 2~8 hours after damage, bone fractures were fixed with locking plates or external fixators, the injured vessel and nerve were repaired by microsurgical technique, and wounds were covered with VSD for the repairation with microsurgical procedure primarily or in the second stage, combinded with postoperatvie comprehensive therapy. Results Only 1 case failed as the result of a large number of muscular necrosis with infection for a long time of heat ischemia, leading to kidney failure and amputation. In other cases all limbs had been saved successfully, 6~48 months of follow-up after operation, and regained weight-bearing walking ability with satisfied functional outcome. Conclusion The correct preoperative assessment, reasonable operation and postoperative comprehensive therapy, can reduce disability rate and effectively save the nearly amputnted lower limb caused by serious composite tissue injury.