显微外科技术结合Ilizarov骨搬运技术治疗小腿GustiloⅢC型损伤

Microsurgical repair combined with Ilizarov technique for Gustilo type ⅢC injuries in leg

[目的]介绍显微外科技术结合Ilizarov骨搬运技术治疗小腿GustiloⅢC型损伤的手术策略和临床疗效。[方法]回顾分析2012年7月~2018年3月治疗GustiloⅢC型小腿毁损伤患者21例,其中男15例,女6例;左侧13例,右侧8例;年龄13~67岁;软组织缺损面积9 cm×7 cm^28 cm×13 cm;骨缺损长度5~13 cm,平均(9.32±2.47)cm。根据肢体毁损情况采取两种手术方式:急诊重建肢体血运+一期或二期游离股前外皮瓣覆盖创面+后期骨搬运16例,急诊重建肢体血运+二期骨与软组织同步搬运5例。出院后门诊定期复查:创面愈合情况,有无局部及钉道感染,滑移骨段是否偏斜,并根据新生骨矿化情况调整搬运速度。[结果]21例患者全部保肢成功,16例皮瓣中1例皮瓣远端皮缘坏死,经植皮后痊愈。软组织及骨缺损均得到修复,骨折端全部愈合。所有患者均获得18~33个月随访,平均(23.74±4.63)个月,末次随访根据ASAMI评分标准进行骨愈合及功能评价:优5例,良11例,可5例,优良率76.19%。[结论]显微外科技术结合Ilizarov骨搬运技术治疗小腿GustiloⅢC型严重毁损伤,临床疗效满意。

[Objective] To introduce the surgical technique and primary clinical outcomes of microsurgical repair combined with Ilizarov technique for Gustilo type ⅢC injuries in leg. [Methods] Twenty-one patients, including 15 males and 6 females aged 13~67 years, received limb salvage treatment for mangled leg injuries from July 2012 to March 2018. The legs were seriously damaged with soft tissue defects ranged from(9×7) cm to(28×13) cm, whereas tibial defects of 5 cm to 13 cm with an average of 9.3 cm in length. Depended on the severity of damage, two strategies of limb salvage were taken, and that was microsurgical vascular repair on emergency combined with same stage wound coverage with free lateral femoral flap, followed by bone transportation by Ilizarov frame in 16 patients, whereas emergent blood supply reconstruction followed by soft tissue and bone reconstruction with Ilizarov technique in the remaining 5 patients. After discharging from hospital, the patients were regularly checked to evaluate wound healing, deal with local and pin tract infection, and adjust transportation of bone fragment based on the new ossification. [Results] All the patients were followed up for 18-33 months, and achieved bony union of the tibia to the latest follow up. According to ASAMI fracture healing score, the clinical outcomes were marked as excellent in 11, good in 5 and fair in 5 patients, associated with excellent and good rate of 76.19%(16/21). [Conclusion] The combination of microsurgical and Ilizarov techniques does obtain satisfactory clinical consequences for mangled legs.