嵌合组织移植在前臂挤压伤中的应用

Application of chimeric tissue transplantation in forearm crush injuries

目的探讨严重前臂挤压伤的组织损伤特点,治疗方法的可行性及临床效果。方法自2013年4月至2021年8月,我科对挤压伤所致前臂严重损伤患者31例进行急诊一期修复,本组挤压部位皮肤缺损面积为5 cm×5 cm~38 cm×8 cm,皮肤撕脱面积为4 cm×10 cm~35 cm×26 cm。肌肉缺损14例。伴有骨缺损7例,缺损长度2~9 cm。完全离断3例。采用创面覆盖、肌肉填塞、肌肉动力重建和骨的修复,皮瓣修复5例,嵌合组织移植23例,双嵌合移植3例。皮瓣面积为16 cm×5 cm~30 cm×9 cm,筋膜面积为9 cm×4 cm~21 cm×11 cm,肌肉体积为10.0 cm×4.0 cm×1.0 cm~25.0 cm×8.0 cm×1.5 cm。定期随访皮瓣外观感觉、骨愈合情况、前臂及手功能情况。结果成功救治29例,截肢2例,血运危象探查5例,手术次数平均2.3次(1~5次),感染4例,骨愈合时间平均5.6个月(3~12个月)。Anderson等功能评分优良率75.9%,差3例(9.7%);DASH上肢障碍功能评分平均32.9;主观评定满意率90.3%。结论各种挤压所致前臂严重复合组织损伤,早期显微组织修复可以获得较好的保肢效果,并恢复一定的功能。

Objective To explore the characteristics of tissue damage,feasibility of treatment methods,and clinical effects of severe forearm crush injury.Methods From April 2013 to August 2021,31 patients with severe forearm injury caused by compression injury were performed emergency primary repair in our department.The skin defect area at the compression site in this group was 5 cm×5 cm to 38 cm×8 cm,with a skin avulsion area of 4 cm×10 cm to 35 cm×26 cm.There were muscle defects in 14 cases.7 cases were accompanied by bone defects,with a defect length of 2 to 9 cm.There were completely severed in 3 cases.The wound coverage,muscle filling,muscle dynamic reconstruction,and bone repair were performed.5 cases underwent skin flap repair,23 cases underwent chimeric tissue transplantation,and 3 cases underwent double chimeric transplantation.The flap area was 16 cm×5 cm to 30 cm×9 cm,with a fascia area of 9 cm×4 cm to 21 cm×11 cm,with a muscle volume of 10.0 cm×4.0 cm×1.0 cm to 25.0 cm×8.0 cm×1.5 cm.The regular follow-up was conducted on skin flap appearance and sensation,bone healing,forearm and hand function.Results Twenty-nine cases were successfully treated,2 cases underwent amputation,5 cases underwent blood circulation crisis exploration,with an average number of surgeries of 2.3(1 to 5).4 cases were infected,and the average bone healing time was 5.6 months(3 to 12 months).The excellent and good rate of the Anderson functional score was 75.9%,with 3 cases(9.7%)remaining poor.The average DASH upper limb dysfunction score was 32.9.The subjective satisfaction rate was 90.3%.Conclusion For the severe composite tissue damage to the forearm caused by various compressions,early microstructural repair can achieve good limb preservation effects and restore certain functions.