分期手术治疗伤口严重污染前臂GUSTILOⅢC型骨折的疗效分析

Effects of staged surgical treatment for forearm GUSTILOⅢC fractures with severe wound contamination

背景伤口严重污染的前臂GUSTILOⅢC型骨折是一种严重的创伤,治疗难度大,目前其治疗方式仍存在争议。目的探讨分期手术治疗伤口严重污染的前臂GUSTILOⅢC型骨折的临床疗效。方法回顾性分析2018年5月-2022年2月在安徽医科大学第一附属医院高新院区显微手足修复重建外科就诊的12例伤口严重污染的前臂GUSTILOⅢC型骨折患者的临床资料。所有患者均使用分期手术完成保肢。一期伤口彻底清创,抗生素骨水泥被覆钢板固定,抗生素骨水泥填充骨缺损。二期取出抗生素骨水泥,采用膜诱导技术植入骨松质,同时更换钢板。观察患者的保肢率、皮瓣愈合、骨愈合、感染控制情况,采用患肢前臂活动度和Enneking评分评价前臂功能恢复情况。结果12例患者男性9例,女性3例,年龄28~62岁(平均45岁)。所有患者均保肢成功,无创面或骨感染,其中1例皮瓣部分坏死,经过清创换药后愈合,其余皮瓣均存活。二期手术后所有患者均骨愈合,愈合时间(8.1±0.9)个月。前臂旋转活动度在术后1~6个月迅速好转,后恢复速度变缓慢,成指数曲线变化[术后1个月:(20.3±3.2)°;术后3个月:(63.4±6.8)°;术后6个月:(82.1±7.3)°;术后8个月:(91.5±6.7)°;术后12个月:(95.2±4.6)°]。Enneking评分则呈稳定线性上升趋势[术后1个月:(4.2±0.9)分;术后3个月:(6.1±0.8)分;术后6个月:(8.2±1.1)分;术后8个月:(11.4±1.4)分;术后12个月:(14.2±1.6)分]。结论分期手术治疗伤口严重污染的前臂GUSTILOⅢC型骨折的疗效满意、并发症少,值得推广应用。

Background Severe wound-contaminated forearm GUSTILOⅢC fracture is a serious and difficult-to-treat trauma,and how to treat it is still controversial.Objective To investigate the effect of staged surgery in treating severe wound-contaminated forearm GUSTILOⅢC fracture.Methods Clinical data about 12 patients with severe wound-contaminated forearm GUSTILOⅢC fracture who were treated in the Department of Microsurgery of Hand and Foot Repair and Reconstruction at the High-tech Hospital of the First Affiliated Hospital of Anhui Medical University from May 2018 to February 2022 were retrospectively analyzed.All patients completed limb salvage with staging operation.The wound was thoroughly debrided in the first stage,then fixed with antibiotic bone cement covered with steel plate,finally filled the bone defect with antibiotic bone cement.In the second stage,the antibiotic bone cement was removed,the cancellous bone was implanted by a membrane induction technique,and the plate was replaced at the same time.The limb salvage rate,flap healing,bone healing and infection were observed,and the forearm range of motion and Enneking score were used to evaluate the recovery of forearm function.Results Of the 12 cases,there were 9 males and 3 females,with age ranged from 28 to 62 years(mean age,45 years).Limb salvage was successful in all patients with no wound or bone infection.One of the flaps was partially necrotic then healed after debridement and dressing change,while the remaining flaps all survived.After the second-stage operation,all patients had bone union,and the healing time was(8.1±0.9)months.Forearm rotational range of motion improved rapidly at 1 to 6 months postoperatively and continued to improve thereafter([20.3±3.2]°at 1 month;[63.4±6.8]°at 3 months;[82.1±7.3]°at 6 months;[91.5±6.7]°at 8 months,[95.2±4.6]°at 12 months).Enneking score showed a stable linear upward trend(4.2±0.9 at 1 month,6.1±0.8 at 3 months,8.2±1.1 at 6 months,11.4±1.4 at 8 months,14.2±1.6 at 12 months).Conclusion Staged operation for severe wound-contaminated forearm GUSTILOⅢC fractures has satisfactory curative effect and fewer complications,which is worthy of further promotion and application.