| 显微外科技术对Gustilo ⅢC型胫腓骨开放性骨折患者的疗效与安全性研究 |
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投稿时间：2023-08-13
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| 作者 | Author | 单位 | Address | E-Mail |
| 王炳 |
WANG Bing |
上海复旦大学附属中山医院吴淞医院骨科, 上海 200940 |
Department of Orthopaedics, Fudan University Affiliated Zhongshan Hospital Wusong Hospital, Shanghai 200940, China |
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| 朱诚 |
ZHU Cheng |
上海复旦大学附属中山医院吴淞医院骨科, 上海 200940 |
Department of Orthopaedics, Fudan University Affiliated Zhongshan Hospital Wusong Hospital, Shanghai 200940, China |
decadentone@163.com |
| 王平 |
WANG Ping |
上海复旦大学附属中山医院吴淞医院骨科, 上海 200940 |
Department of Orthopaedics, Fudan University Affiliated Zhongshan Hospital Wusong Hospital, Shanghai 200940, China |
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| 吴子征 |
WU Zi-zheng |
上海复旦大学附属中山医院吴淞医院骨科, 上海 200940 |
Department of Orthopaedics, Fudan University Affiliated Zhongshan Hospital Wusong Hospital, Shanghai 200940, China |
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| 期刊信息：《中国骨伤》2025年，第38卷，第1期，第41-46页 |
| DOI：10.12200/j.issn.1003-0034.20230382 |
| 基金项目:上海宝山区医学重点学(专)科及特色品牌建设项目(编号:BSZK-2023-Z04) |
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中文摘要:
目的: 分析Gustilo ⅢC型开放性骨折患者采用显微外科技术的疗效，并观察其安全性。
方法: 选择2018年9月至2022年3月医院收治的64例Gustilo ⅢC型胫腓骨开放性骨折患者，分为观察组与对照组，各32例。观察组中男24例，女8例;年龄29~42(36.59±3.24)岁;胫骨缺损2~5(3.41±0.61) cm;软组织缺损面积34~76(58.50±9.44) cm2;采取显微外科技术治疗。对照组中男25例，女7例;年龄27~44(37.59±3.21)岁;胫骨缺损2~6(3.59±0.80) cm;软组织缺损面积36~78(59.09±9.53) cm2;采取常规分期手术治疗，Ⅰ期清创后予以石膏或支具辅助固定，Ⅱ期采用适当内固定治疗。比较两组Anderson评分、运动功能Fugl-Meyer评分、围术期相关指标、康复情况、随访结果、并发症发生情况。
结果: 两组患者均获得随访，时间2.5~5.5(3.15±1.11)个月。观察组优19例，良12例，可1例，差0例;对照组优11例，良13例，可6例，差2例;两组比较差异有统计学意义(P<0.05)。观察组手术时间(4.39±0.69) h、住院时间(30.22±4.58) d，住院费用(2.35±0.33)万元，低于对照组[(5.01±0.75) h、(33.28±3.74) d、(3.02±0.52)万元]，P均<0.05。观察组血运重建时间(134.25±14.76) h、伤口愈合(11.34±1.56) d、骨折愈合时间(3.09±0.42)个月，均短于对照组[(189.36±22.17) h、(13.22±2.03) d、(4.02±0.57)个月]，P均<0.05。观察组术后6个月运动能力(42.91±5.51)分、感觉功能(46.19±3.53)分及Fugl-Meyer总分(89.09±6.08)分，均高于对照组(35.19±4.27)、(34.03±3.79)、(69.22±6.32)分，P<0.05。观察组难愈创面1例、完全性神经损伤3例，对照组分别为8、10例，两组比较差异有统计学意义(P<0.05)。
结论: 显微外科技术可有效缩短Gustilo ⅢC型开放性骨折患者伤口及骨折愈合时间，提升患者肢体运动能力，降低预后不良及并发症风险。 |
| 【关键词】Gustilo ⅢC型开放性骨折 显微外科技术 肢体功能 |
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| Efficacy and safety of microsurgery in patients with Gustilo ⅢC open fractures |
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ABSTRACT
Objective To analyze the clinical efficacy and safety of microsurgery in patients with Gustilo ⅢC open fractures.
Methods A total of 64 patients with Gustilo ⅢC open fractures who were admitted to the hospital bewteen September 2018 and March 2022 were included,and divided into the observation group and the control group,with 32 cases in each one. In the observation group,there were 24 males and 8 females,aged from 29 to 42 years with an average of (36.59±3.24) years. The tibial defect ranged from 2 to 5 cm with an average of (3.41±0.61) cm,and the soft tissue defect area ranged from 34 to 76 cm2 with an average of (58.50±9.44) cm2. This group received microsurgical treatment. In the control group,there were 25 males and 7 females,aged from 27 to 44 years with an average of (37.59±3.21) years. The tibial defect ranged from 2 to 6 cm with an average of (3.59±0.80) cm,and the soft tissue defect area ranged from 36 to 78 cm2 with an average of (59.09±9.53) cm2. This group received conventional staged surgery,with plaster or brace fixation after initial debridement and appropriate internal fixation at a later stage. The Anderson scores,motor ability Fugl-Meyer scale,perioperative indicators,rehabilitation outcomes,and complications were compared between the two groups.
Results The patients were followed up for a duration from 2.5 to 5.5 months with an average of (3.15±1.11) months. In the observation group,19 patients were rated as excellent,12 patients as good,1 patient as fair,and no patients as poor. In the control group,11 patients were rated as excellent,13 patients as good,6 patients as fair,and 2 patients as poor. The difference in outcomes between the two groups was statistically significant (P<0.05). The operation time,the hospitalization time,and the hospitalization cost in the observation group(4.39±0.69) h,(30.22±4.58) d,and (23,500±3,300) yuan,respectively were significantly lower than those in the control group(5.01±0.75) h,(33.28±3.74) d,and(30,200±5,200) yuan,respectively (P<0.05). Revascularization time(134.25±14.76) h,wound healing time(11.34±1.56) d,and fracture healing time(3.09±0.42) months in the observation group were significantly shorter than those in the control group(P<0.05) which were (189.36±22.17) h,(13.22±2.03) d and (4.02±0.57) months respectively. The motor ability(42.91±5.51) points,sensory function(46.19±3.53) points,and total Fugl-Meyer score(89.09±6.08) in the observation group were significantly higher than those in the control group(P<0.05) which were(35.19±4.27),(34.03±3.79),(69.22±6.32) points respectivdy. In the observation group,there were 1 case of refractory wound and 3 cases of complete nerve injury,which were lower than those in the control group (8 cases and 10 cases,respectively,P<0.05). The number of complications in the observation group was lower than that in the control group (P<0.05).
Conclusion Microsurgical technique can effectively shorten the wound and fracture healing time in patients with Gustilo Ⅲ C open fracture,improve limb movement ability,and reduce the risk of poor prognosis and complications. |
| KEY WORDS Gutilo ⅢC open fracture Microsurgical techniques Limb function |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 王炳,朱诚,王平,吴子征.显微外科技术对Gustilo ⅢC型胫腓骨开放性骨折患者的疗效与安全性研究[J].中国骨伤,2025,38(1):41~46 |
| 英文格式: | WANG Bing,ZHU Cheng,WANG Ping,WU Zi-zheng.Efficacy and safety of microsurgery in patients with Gustilo ⅢC open fractures[J].zhongguo gu shang / China J Orthop Trauma ,2025,38(1):41~46 |
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