股外侧肌浅区嵌合移植急诊一期修复前臂严重挤压伤的临床效果

Clinical effects of emergency primary repair for severe crush injury of forearms with chimeric transplantation of the lateral femoral muscle superficial region

目的探讨股外侧肌浅区嵌合移植修复前臂严重挤压伤的可行性及临床效果。方法2012年5月至2022年3月,西安凤城医院手足显微外科对挤压所致的前臂严重损伤患者30例进行急诊一期修复。患者均有尺桡骨双侧或单侧粉碎性骨折、皮肤缺损,或伴有血管、骨及肌肉等组织复合性损伤。采用股外侧肌浅区嵌合移植进行创面覆盖、肌肉填塞、肌肉动力重建和骨的修复。术后每3个月通过患者来院复查、电话、微信等进行随访,记录皮瓣外观及感觉功能、骨愈合、前臂及手功能情况。结果成功救治28例,保肢率93.33%;血运危象探查7例,手术次数1~5次,平均2.6次,感染率6.67%;骨愈合时间3~10个月,平均6.7个月。术后6个月Anderson功能评分优良率71.4%;上肢功能障碍(DASH)评分平均34.2分。结论股外侧肌浅区嵌合移植急诊修复前臂严重挤压所致的复合组织损伤,可以获得较高的保肢率,并恢复一定的前臂功能。

Objective To investigate the feasibility and clinical effects of chimeric transplantation of the lateral femoral muscle superficial region to repair severe crush injury of forearms.Methods From May 2012 to March 2022,emergency primary repair of severely injured forearms caused by crush in 30 cases in Department of Hand and Podiatric Microsurgery,Xi′an Fengcheng Hospital was carried out.Bilateral or unilateral comminuted fractures of the ulna and radius,skin defects,or combined injuries of blood vessels,bone and muscle tissues were found in all of the patients.Wound covering,muscle tamponade,reconstruction of muscle dynamics and bone repair were performed.Patients were followed up every 3 months after surgery through reexamination,phone or WeChat,recorded the flaps looked and sensory function,bone healed and the functions of forearms and hands.Results The forearms of 28 cases were treated,and the limb salvage rate was 93.33%.Exploration of blood vessel was conducted in 7 cases.The number of operations was 1-5,with an average of 2.6.The infection rate was 6.67%.The bone healing time was 310 months,with an average of 6.7 months.According to the Anderson score,the rate of excellent and good outcomes of surgery was 71.4%at 6 months after surgery.The average score of the disabilities of the arm,shoulder and hand(DASH)questionnaire was 34.2.Conclusion The chimeric transplantation of the lateral femoral muscle superficial region used to repair the combined injuries of forearms caused by the severe crush,can increase the limb salvage rate,and restore some functions of the forearms.