海水浸泡踝膝关节开放损伤的治疗

Treatment of Open Ankle and/or Knee Joints Injurv after Seawater Immersion

目的:探讨海水浸泡踝、膝关节开放损伤的治疗。方法:自1986-02～2003-01,海水浸泡踝、膝关节开放损伤共41例47个关节,均于彻底清创后关节内骨折复位内固定、一期闭合创面、一期行局部皮瓣或肌皮瓣转移修复关节周围软组织明显缺损。结果:皮瓣或肌皮瓣全部存活。创部Ⅱ/甲愈合25个关节(占51.2％),Ⅱ/乙愈合18个关节(占38.3％),仅4个关节出现感染征象(占8.5％)。随访6个月～16年10个月,关节内骨折均愈合,踝、膝关节功能恢复满意,膝关节功能优6例,良4例,可1例;踝关节功能优14例,良8例,可1例,差1例。但是,伤后5～7年以上者匀出现不同程度的关节退变表现。结论:海水浸泡时间不超过2h、伤后时间在6～8h以内的踝、膝关节开放损伤,均可于彻底清创后一期处理关节内骨折和闭合创面,局部皮瓣或肌皮瓣转移修复软组织缺损是可行的。

Objective To explore surgical procedure for open ankle and/or knee joints injury after seawater immersion. Methods From February 1986 to January 2003,41 cases with 47 ankle and/or knee joints open injuries 5-135 minutes after seawater immersion were treated. The joints wound were thoroughly debrided, and then intraarticular fractures were reduced and fixed. The one - stage wound closure was employed, and cutaneous or musculocutaneous flaps were transferred locally to repair the periarticular soft tissue defects. Results All the flaps survived. Of 47 injured joints,25 gained the healing by first intention of the wounds and intraarticular fractures, 18 by second intention, and 4 were infected and healed by anti - inflammatory agent. The following up from 6 months to 16 years and 10 months showed that the functions of the injured ankle or knee joints were satisfactory, but the degenerative changes were observed in the injured joints more than 5 to 7 years after the operation. Conclusions The reduction and fixation of intraarticular fracture and one- stage closure of the wound can be employed during surgical procedures in open ankle and/or knee joints injuies which are treated within 8 hours after the seawater immersion of die wounds for less than 2 hours. The local cutaneous or musculocutaneous flaps may be applied to repairing soft tissue defects after thorough debridement in these patients.