组织皮瓣移植联合骨延长技术修复伴有软组织缺损的创伤性骨损伤

Tissue flap transplantation combined with bone lengthening for repair of traumatic bone injury with soft tissue defect

目的探讨组织皮瓣移植修复联合骨延长技术对伴有软组织缺损的创伤性骨损伤的临床修复效果。方法对2016年1月至2018年3月我院收治的26例伴有软组织缺损的创伤性骨损伤患者实施分期组织皮瓣移植修复联合骨延长技术治疗,一期彻底清创缺损创面周围坏死组织,明确组织缺损边界及性状,清除损伤断骨端病变骨质及碎骨;二期运用Ilizarov环形外固定延长架骨延长技术或Orthofix单边外固定支架持续骨延长修复骨缺损,运用组织皮瓣移植修复缺损软组织,加强创面换药,促进皮瓣成活,观察皮瓣及新生骨痂愈合情况。结果皮瓣移植后2例存在皮下积液、窦道,经扩创、去除坏死组织及抗生素骨水泥间隔填充治疗后愈合,3例出现皮瓣温度较低,血供不良,经调整皮瓣压力,烤灯照射等对症处理,最终所有皮瓣均存活,切口Ⅰ期愈合;2例骨牵引针道感染,加强抗感染治疗得到控制。平均外固定持续牵引时间(5.7±0.6)个月,平均皮肤愈合时间(4.5±0.9)周,平均骨缺损愈合时间(10.8±2.1)个月。所有患者均未发生神经血管损伤、骨髓炎、骨外露、畸形等并发症。结论组织皮瓣移植修复联合骨延长技术对伴有软组织缺损的创伤性骨损伤修复效果显著。

Objective To explore the clinical repair effect of tissue flap transplantation combined with bone extension technique on traumatic bone injury with soft tissue defect.Methods From January 2016 to March 2018, 26 patients with traumatic bone injury with soft tissue defects were treated with staged tissue flap repair combined with bone extension technique. The first stage completely debrided the necrotic tissue around the defect. Defining the defect boundary and traits of the tissue, clearing the bone and bone of the injured bone at the end of the fracture;using the Ilizarov annular external fixation extension bone extension technique or the Orthofix unilateral external fixation stent to repair the bone defect, and using tissue flap transplantation Repair the soft tissue of the defect, strengthen the wound dressing, promote the survival of the flap, and observe the healing of the flap and the new callus. Results Two cases of subcutaneous effusion and sinus were found after flap transplantation. They were healed after expansion, removal of necrotic tissue and antibiotic bone cement filling. Three cases showed lower flap temperature, poor blood supply, and adjusted flap pressure. Symptomatic treatment such as roasting lamp irradiation, all the flaps survived, and the incision healed in the first stage;2 cases of bone traction needle infection and enhanced anti-infective treatment were controlled. The average external fixation sustained traction time(5.7 ± 0.6) months, the average skin healing time(4.5 ± 0.9) weeks, and the average bone defect healing time(10.8 ± 2.1) months. All patients had no complications such as neurovascular injury, osteomyelitis, bone exposure, and deformity. Conclusion The tissue flap repair combined with bone extension technique has a significant effect on the repair of traumatic bone injury with soft tissue defects.