骨外固定减张牵引对肢体创面愈合的作用

Application of tension-reducing distraction of external fixators for limb wound closure

目的探讨骨外固定减张牵引对肢体创面愈合的效果。方法采用回顾性病例系列研究分析2016年1月至2019年7月解放军联勤保障部队第九二〇医院收治的21例皮瓣难以覆盖的肢体创面患者临床资料,其中男15例,女6例;年龄11~56岁[(37.8 ± 11.2)岁]。创面部位:下肢15例,上肢6例。缺损面积:1.2 cm×1.0 cm~22.0 cm×17.1 cm。肢体创面清创后,根据创面形状和部位,使用Ilizarov骨外固定减张牵引装置。术后第1天开始,以1 mm/d的速度缓慢牵张,并根据创面的皮肤闭合角度调整牵引方向。观察创面减张牵引、创面愈合时间。采用伤口临床愈合评分评估术后5,30 d伤口愈合情况。根据Paley分类标准记录并发症情况。绘制创面愈合生存曲线,观察创面减张牵引中位时间、愈合中位时间及最终创面愈合情况。结果患者均获随访3~9个月[(4.5 ± 1.7)个月]。创面经过装置减张牵引后均得到明显缩小,减张牵引时间为6~23 d[(7.8 ± 2.3)d],创面愈合时间15~47 d[(23.0 ± 3.3)d]。临床愈合评分术后5 d为(3.2 ± 0.9)分,30 d为(0.7 ± 0.2)分(P < 0.05)。Paley分类并发症出现15个问题,0个障碍,0个后遗症。创面生存曲线显示减张牵引中位时间为16 d,创面愈合中位时间34 d。最终创面直接关闭愈合10例,植皮愈合8例,缝合愈合3例。所有创面愈合后无复发。结论对于皮瓣难以覆盖肢体创面,骨外固定减张牵引装置可有效闭合,促进创面愈合,且疗程短,并发症少,创面复发率低。

Objective To explore the effect of tension-reducing distraction of external fixators for limb wound closure.Methods A retrospective case series study was made on data of 21 patients with refractory limb wounds admitted to 920th Hospital of Joint Logistics Support Force of PLA from January 2016 to July 2019.There were 15 males and 6 females,aged 11 to 56 years[(37.8±11.2)years].The lower-limb wounds were found in 15 patients and the upper-limb wound in 6 patients.The area of wound defect ranged from 1.2 cm×1.0 cm to 22.0 cm×17.1 cm.After debridement of the limb wound,the tension-reducing distraction of Ilizarov external fixators was used according to the shape and location of the wound.Distraction was applied at a rate of 1 mm/d starting at postoperative day 1 and the direction of distraction was adjusted according to the angle of skin closure of the trauma.The wound reduction distraction time and wound healing time were recorded.The wound healing score was used to evaluate wound healing at postoperative 5 days and 30 days.Complications were recorded according to the Paley classification.The wound survival curve was plotted to observe the time of wound tension reduction and traction and wound healing.The final wound healing was detected as well.Results All patients were followed up for 3 to 9 months[(4.5±1.7)months].The wounds were significantly reduced after reduction and distraction,with the reduction time of 6-23 days[(7.8+2.3)days]and the wound healing time of 15-47 days[(23.0±3.3)days].The wound healing score was(3.2±0.9)points at postoperative 5 days and(0.7±0.2)points at postoperative 30 days(P<0.05).There were 15 problems,0 disorder,and 0 sequelae according to the Paley classification of complications.The wound survival curve showed the median time of reduction and distraction and wound healing was 16 days and 34 days,respectively.All patients showed wound healing without recurrence,of which 10 were healed directly,8 by implants and 3 by sutures.Conclusion For patients with limb wounds difficult to be treated by flap coverage,the tension-reducing distraction of external fixators can effectively close the wound,fasten wound healing,shorten treatment period,and has fewer complications and a low recurrence rate.