四肢复杂性骨折的修复与重建

Repair and Reconstruction of Complex Fractures in the Extremties

目的 探索四肢复杂性骨折修复之疗效。方法 对56例(胫、腓骨38例,肱骨11例,股骨7例)多平面粉碎性开放性骨折,其中合并血管损伤32例,血管神经同时损伤14例,10例并有神经损伤。46例一期进行损伤血管、神经与骨折的修复与重建,10例进行二期损伤神经、骨折修复。结果 术后经8～36个月随访,56例均获骨性愈合,修复的血管通畅,重建神经及肢体功能恢复良好。结论 在彻底清创基础上采用吻合血管游离腓骨移植重建多平面严重粉碎性骨折的连续性,利用腓动脉桥接修复损伤肢体主要动脉,不但使难治型骨折获良好愈合,损伤动脉也获修复,从而极大挽救肢体功能,减低了肢体致残率与截肢率。

Objective To probe treatment effectiveness of the repair and reconstruction of complex fractures in the extremities. Methods Fifty-six cases of severe comminuted fractures were treated since 1996. Complicated blood vessels injuries were found in 32 cases, and complicated nerves injury in 10 cases. In another 14 cases complicated blood vessels and nerves injury were found simultaneously. Forty-six cases were repaired for their fractures and blood vessels and nerves injury at one stage and 10 cases were repaired at the second stage. Results With the follow-up 8 to 36 months postoperatively, All 56 cases had bony healing and unobstructed blood vessels. The function of extremities recovered well. Conclusion On the basis of thorough debridement, severe comminuted fractures in the four extremities could be treated with fibula grafts with blood vessel anastomosed, and main arteries in extremities are also repaired in the same time. The function of wounded extremities can recover very well.