二期创面修复治疗严重上肢创伤骨折疗效分析

Clinical analysis of secondary wound repair in the treatment of severe upper limb traumatic fracture

目的探讨上肢严重创伤骨折患者采用二期创面修复治疗的临床效果。方法选取实施手术治疗的36例上肢GustiloⅢB、ⅢC型患者作为研究对象,所有患者均采用一期清创、骨折固定、血管及神经修复后采用负压封闭引流(VSD)覆盖创面,术后5~18天实施二期皮瓣移植创面修复手术;观察患者的创面愈合时间、骨折愈合时间、术后患者前臂功能恢复情况。结果36例患者均顺利完成一期手术,有1例患者因软组织严重坏死于一期手术后第7天实施截肢手术,其余35例患者均分别于一期手术后5~18天实施二期皮瓣移植修复术,均成功保肢,其中股前外侧穿支皮瓣修复17例、背阔肌肌皮瓣修复14例、上臂外侧皮瓣修复4例;患者住院时间为15~65天,平均(28.9±6.2)天,术后创面愈合时间为24~46天,平均(30.5±4.5)天;骨折愈合时间为12~20周,平均(15.3±2.2)周;分别于二期手术术后4月、8月对两组患者进行患肢功能评价,在术后8月时,35例保肢患者的前臂旋前、前臂旋后、腕背伸、腕背屈、腕桡偏、腕尺偏度数功能、Mayo评分均显著改善,优于术后4月,差异具有统计学意义(P<0.05)。结论上肢严重创伤骨折患者采用二期创面修复治疗对于骨折愈合、创面修复均具有肯定的临床效果,术后上肢功能恢复尚可。

Aim To investigate the clinical effects of secondary wound repair in patients with severely injured upper limb fractures.Methods Thirty-six patients with upper limb GustiloⅢB andⅢC who underwent surgical treatment were selected as the research objects.All patients were treated with debridement,fracture fixation,and vascular and nerve repair with negative pressure closed drainage(VSD)to cover the wound.A two-stage flap graft repair was performed within 18 days;the wound healing time,fracture healing time,and forearm function recovery of the patients were observed.Results All 36 patients successfully completed the first-stage operation.One patient underwent amputation at day 7 after the first-stage operation due to soft tissue necrosis.The remaining 35 patients underwent second-stage flap repair within 5~18 days after the first stage operation,and all of them successfully preserved their limbs,including 17 cases of anterior and lateral femoral perforator flap repair,14 cases of latissimus dorsi muscle flap repair and 4 cases of upper arm lateral flap repair;The hospitalization time was 15~65 days(average 28.9±6.2)days,the wound healing time was 24~46 days(average 30.5±4.5)days,and the fracture healing time was 12~20 weeks(average 15.3±2.2)weeks;The functional evaluation of the affected limbs was performed 4 months and 8 months after the second stage operation.At 8 months after operation,the forearm pronation,forearm pronation,wrist extension,wrist dorsiflexion,wrist radial deviation,wrist ulnar deviation number function and Mayo score of 35 patients were significantly improved,which was better than that of 4 months after operation(P<0.05).Conclusion Patients with severe trauma to the upper limbs who have undergone secondary wound repair have a positive clinical effect on fracture healing and wound repair,and upper limb function recovery is acceptable after surgery.