| 内外联合固定结合Ⅱ期穿支血管蒂皮瓣治疗Gustilo-AndersonⅢB及ⅢC型踝关节骨折脱位 |
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Received:February 10, 2020
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| 作者 | Author | 单位 | Unit | E-Mail |
| 侍朋举 |
SHI Peng-ju |
唐山市第二医院创伤骨科, 河北 唐山 063000 |
Department of Traumatic Orthopaedics, the Second Hospital of Tangshan, Tangshan 063000, Hebei, China |
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| 孙柏山 |
SUN Bai-shan |
唐山市第二医院创伤骨科, 河北 唐山 063000 |
Department of Traumatic Orthopaedics, the Second Hospital of Tangshan, Tangshan 063000, Hebei, China |
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| 张瑞杰 |
ZHANG Rui-jie |
唐山市第二医院创伤骨科, 河北 唐山 063000 |
Department of Traumatic Orthopaedics, the Second Hospital of Tangshan, Tangshan 063000, Hebei, China |
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| 王建生 |
WANG Jian-sheng |
唐山市第二医院创伤骨科, 河北 唐山 063000 |
Department of Traumatic Orthopaedics, the Second Hospital of Tangshan, Tangshan 063000, Hebei, China |
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| 齐巍 |
QI Wei |
唐山市第二医院创伤骨科, 河北 唐山 063000 |
Department of Traumatic Orthopaedics, the Second Hospital of Tangshan, Tangshan 063000, Hebei, China |
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| 左金增 |
ZUO Jin-zeng |
唐山市第二医院创伤骨科, 河北 唐山 063000 |
Department of Traumatic Orthopaedics, the Second Hospital of Tangshan, Tangshan 063000, Hebei, China |
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| 赵刚 |
ZHAO Gang |
唐山市第二医院创伤骨科, 河北 唐山 063000 |
Department of Traumatic Orthopaedics, the Second Hospital of Tangshan, Tangshan 063000, Hebei, China |
zhaog998@126.com |
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| 期刊信息：《中国骨伤》2020年33卷，第7期，第596-601页 |
| DOI：10.12200/j.issn.1003-0034.2020.07.002 |
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目的： 探讨采用内外联合固定结合Ⅱ期穿支血管蒂皮瓣治疗Gustilo-AndersonⅢB、ⅢC型踝关节骨折脱位的临床疗效。
方法： 自2014年5月至2017年7月采用内外联合固定结合Ⅱ期穿支血管蒂皮瓣治疗20例Gustilo-AndersonⅢB、ⅢC型踝关节骨折脱位患者，其中男14例，女6例；年龄18~58（39.0±9.7）岁；Gustilo-Anderson损伤分型：ⅢB型17例，ⅢC型3例；踝关节骨折AO分型：A型4例，B型7例，C型9例；创面大小4 cm×3 cm~20 cm×9 cm。Ⅱ期穿支皮瓣：胫后动脉穿支蒂皮瓣11例，腓动脉穿支皮瓣5例，前踝上皮瓣1例，胫后动脉穿支皮瓣联合腓动脉穿支皮瓣3例。观察术后伤口愈合、皮瓣成活及骨折愈合情况，末次随访时采用AOFAS踝与后足评分系统评价临床疗效。
结果： 20例肢体全部保肢成功，无截肢患者。9例患者出现浅表感染，无深部感染及骨髓炎发生。其中19例皮瓣全部成活。所有患者获得随访，时间6~18（12.0±2.9）个月。皮瓣愈合良好，无窦道及骨外露发生，未出现骨不连。骨折愈合时间4~10（6.6±1.7）个月。术后AOFAS评分为（76.7±16.4）分，其中优4例，良11例，可3例，差2例。
结论： 内外联合固定结合Ⅱ期穿支血管蒂皮瓣治疗Gustilo-AndersonⅢB、ⅢC型踝关节骨折脱位可有效闭合创面，促进骨折愈合，可最大限度恢复肢体外观及功能。 |
| [关键词]:踝关节 骨折脱位 穿支皮瓣 骨折固定术 |
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| Internal and external fixation combined with second-stage perforator flap for the treatment of ankle fracture dislocation of Gustilo-Anderson types ⅢB and Ⅲ C |
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Abstract:
Objective: To explore clinical effect of internal and external fixation combined with second-stage perforator fiap for the treatment of ankle fracture dislocation of Gustilo-Anderson types ⅢB and ⅢC.
Methods: From May 2014 to July 2017,20 patients with Gustilo-Anderson types ⅢB and ⅢC ankle fracture dislocation were treated with internal and external fixation combined with second-stage perforator fiap,including 14 males and 6 females,aged from 18 to 58 years old with an average of (39.0±9.7) years old;17 patients were type ⅢB and 3 patients were type ⅢC according to Gustilo-Anderson classification;4 patients were type A,7 patients were type B,and 9 patients were type C according to AO classification. The size of wound ranged from 4 cm×3 cm to 20 cm×9 cm. Second-stage perforator flap,11 patients were performed with posterior tibial artery perforator flap,5 patients were performed with fibular artery perforator flap,1 patient was performed with anterior ankle flap,and 3 patients were performed with posterior tibial artery perforator flap combined with fibular artery perforator flap. Postoperative wound healing,flap survival and fracture healing were observed,AOFAS score was used to evaluate at the latest follow-up.
Results: All limbs were preserved successfully without amputation. Nine patients occurred superficial infection without deep infection and osteomyelitis occurring. The flaps of 19 patients survived. All patients were followed up for 6 to 18 months with an average of(12.0±2.9) months. The flaps healed well without sinus tract,bone exposure and bone disunion occurring. Fracture healing time ranged from 4 to 10 months with an average of(6.6±1.7) months. Postoperative AOFAS score was 76.7±16.4,among which 4 patients got excellent result,11 patients good,3 patients fair,and 2 poor.
Conclusion: Internal and external fixation combined with second-stage perforator fiap for the treatment of ankle fracture dislocation of Gustilo-Anderson types ⅢB and ⅢC could effectively close the wound,improve fracture healing and restore appearance and function of limbs to the maximum. |
| KEYWORDS:Ankle joint Fracture dislocation Perforator flap Fracture fixation |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 侍朋举,孙柏山,张瑞杰,王建生,齐巍,左金增,赵刚.内外联合固定结合Ⅱ期穿支血管蒂皮瓣治疗Gustilo-AndersonⅢB及ⅢC型踝关节骨折脱位[J].中国骨伤,2020,33(7):596~601 |
| 英文格式: | SHI Peng-ju,SUN Bai-shan,ZHANG Rui-jie,WANG Jian-sheng,QI Wei,ZUO Jin-zeng,ZHAO Gang.Internal and external fixation combined with second-stage perforator flap for the treatment of ankle fracture dislocation of Gustilo-Anderson types ⅢB and Ⅲ C[J].zhongguo gu shang / China J Orthop Trauma ,2020,33(7):596~601 |
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