ⅢC型开放性胫骨骨折软组织缺损的处理

doi:10.3877/cma.j.issn.1674-0785.2019.07.003

中华临床医师杂志(电子版) ›› 2019, Vol. 13 ›› Issue (07) : 493 -497. doi: 10.3877/cma.j.issn.1674-0785.2019.07.003

所属专题：骨科学；文献；

临床研究

ⅢC型开放性胫骨骨折软组织缺损的处理

张功林¹, 师富贵¹, 王行高¹, 胡军¹^,^†(

), 冯致举¹, 何如祥¹, 王世东², 郑明²

^1. 730050　甘肃省兰州市兰州手足外科医院骨科
^2. 735000　甘肃省酒泉市酒钢医院骨科

收稿日期:2019-02-11 出版日期:2019-04-01
通信作者: 胡军
基金资助:
兰州市科学技术局项目(2018-4-60)

Treatment of soft tissue defect in type IIIC open tibial fractures with a pedicled muscle flap

Gonglin Zhang¹, Fugui Shi¹, Xinggao Wang¹, Jun Hu¹^,^†(), Zhiju Feng¹, Ruxiang He¹, Shidong Wang², Ming Zheng²

^1. Department of Orthopedic Surgery, Lanzhou Hand and Foot Surgery Hospital, Lanzhou 730050, China
^2. Department of Orthopedics, Jiugang Hospital, Jiuquan 735000, China

Received:2019-02-11 Published:2019-04-01
Corresponding author: Jun Hu
About author:
Corresponding author: Hu Jun, Email: 668ZGL@163.com

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目的

报告ⅢC型开放性胫骨骨折软组织缺损处理的临床效果。

方法

自2011年1月至2016年10月，甘肃省兰州市兰州手足外科医院骨科应用以胫后动脉为蒂半比目鱼肌瓣治疗对侧ⅢC型胫骨开放性骨折患者17例（男性15例，女性2例）。患者年龄为26～49岁（平均36岁）。软组织缺损的面积为8 cm×8 cm~13 cm×7 cm。肌瓣和血管蒂表面行一期中厚网状游离植皮，供区直接缝合。

结果

肌瓣全部成活，术后没有发生血管危象，其中1例发生肌瓣远端小块植皮坏死，经2周换药处理自然愈合。术后随访2.8~5.5年，平均3.9年，胫、腓骨骨折全部愈合，受区外形较好，取得了满意的临床效果。

结论

该方法适用于治疗对侧ⅢC型胫骨开放性骨折，减轻了对供区的损伤。

关键词: 胫骨, 骨折，开放性, 带蒂肌瓣

Objective

To assess the clinical effect of using a pedicled muscle flap in the treatment of soft tissue defect in type IIIC open tibial fractures.

Methods

Between January 2011 and October 2016, 17 patients with type IIIC open tibial fractures were treated with a contralateral hemisoleus muscle flap pedicled on the posterior tibial artery. They ranged in age from 26 to 49 years (mean, 36 years). The size of the soft-tissue defects ranged from 8×8 cm to 13 cm×7 cm. The immediate coverage of the muscle flaps and vessel pedicle were performed using a meshed split-thickness skin graft. The donor site was closed directly.

Results

All the muscle flaps had survived completely. No clinical vascular deficiency was found on the muscle flaps postoperatively. One case developed a small area of skin graft necrosis on the distal muscle flap, which healed after 2 weeks of dressing changes. The follow-up period ranged from 2.8-5.5 years (mean, 3.9 years) postoperatively. The tibia and fibula fractures healed. A good contour was confirmed at the recipient area. Satisfactory clinical results were obtained in this series.

Conclusion

Pedicled muscle flap is suitable for treatment of type IIIC open tibia fractures and reduces the injury to donor site.

Key words: Tibia, Fractures, Open, Pedicled muscle flap

图1 弹性血管蒂阻断训练器制做（橡皮筋和套管）

图2 弹性血管蒂阻断训练器使用方法示意（橡皮筋环绕血管蒂再穿过套管）

图3 ⅢC型左胫骨开放性骨折术前创面情况

图4 健侧半比目鱼肌瓣已切取

图5 肌瓣修复对侧软组织缺损行网孔状植皮后外形（两腿之间为血管蒂）

图6 术后16 d肌瓣全部成活，行断蒂训练操作（血管钳维持橡皮筋松紧度）

图7 断蒂后取下的血管蒂

图8 术后8周外形

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