外固定支架与小腿皮瓣在开放性胫腓骨骨折中的临床应用

目的：报道外固定支架结合小腿内侧筋膜皮瓣在修复开放性胫腓骨骨折骨外露中的手术方法及临床应用。方法：自1998年8月～2003年5月应用外同定支架结合逆行或顺行小腿内侧筋膜皮瓣一期修复开放性胫腓骨骨折并骨外露30例。结果：30例随访4个月到5年，术后筋膜皮瓣全部成活，切口Ⅰ期愈合28例，Ⅱ期愈合2例；27例胫腓骨骨折获得临床愈合，骨折愈合时间平均为5个月，骨折愈合时间最长为术后8个月；3例骨不愈合，1年后行切开植骨术而痊愈，不愈合率10％；2例有不同程度感染，其中1例并发慢性骨髓炎．术后感染率6．7％：结论：小腿内侧筋膜皮瓣血供良好，手术操作简单、不损伤小腿主要血管等优点，结合外固定支架技术是修复开放性胫腓骨骨折骨外露的一种可供选用的方法，特别适合于基层医院开展。

Clinical application of outside bone holding framework in combination with crural fasciocutaneous free flaps in reconstruction of open tibia and fibula bone fractures

To report the operation ways and clinical application of outside bone holding framework in combination with medialis crural fasciocutaneous free flaps (anterograde or reverse)in reconstruction of open tibia and fibula bone fractures associated with bone exposure. Methods: Thirty patients suffered from open tibia and fibula bone fractures associated with skin defects had been performed the operations of outside bone holding framework in combination with internal crus fasciocutaneous free flaps from Aug 1998 to May 2003. Results: Followed up for 4 months to 5 years, all fasciocutaneous free flaps were alive, 28 cases reached the primary healing and 2 cases reached the secondary healing. The average fractures healing time was 5 months, except for 3 nonunions which were healed by bone graft after one year. Two cases were infected, and one developed complication of chronic esteomyelitis. The infected rate was 6.7%. Conclusions: The medialis crus free flap has advantages of well blood supplying, simple operation, and noinjuring for major blood vessels etc. The operation way of medialis crus free flap in combination with outside bone holding framework to reconstruct open tibia and fibula bone fractures associated with bone exposure is a better way and particularly suitable for basic level hospitals.