人工皮覆盖技术加外固定器在小腿重度开放骨折中的应用

目的:研究治疗小腿严重开放性骨折的有效治疗方法。方法:自2009年1月至2011年2月治疗56例严重小腿开放骨折患者,其中男42例,女14例;年龄18～68岁,平均43.6岁。清创后骨折用外固定支架固定加人工皮覆盖,接负压封闭吸引,5～7d后Ⅱ期缝合、植皮或皮瓣转移。观察创面修复情况、创面细菌培养情况、骨折愈合时间及患肢功能恢复情况并分析治疗疗效。结果:56例创面均愈合,平均愈合时间5.8个月。骨折愈合53例,延迟愈合3例。浅表感染1例,针道感染3例,无其他并发症。参照Ovadia等关节功能评定标准,优45例,良9例,可2例。结论:人工皮覆盖技术联合外固定支架治疗小腿GustiloⅢ型开放骨折,能促进创面修复及骨折愈合,缩短病程,值得推广。

Application of artificial skin combined with external fixator in the treatment of severe open fractures of legs

Objective:To investigate therapeutic effects of external fixator combined with artificial skin for the treatment of lower limb open fractures. Methods:From January 2009 to February 2011,56 patients with lower limb open fractures were treated with external fixator and artificial skin following debridement. There were 42 males and 14 females ,with a mean age of 43.6 years (ranged,18 to 68 years). Wound surface or cavities were filled with artificial skin with embedded drainage tubes connected to vacuum bottle. The wounds were closed with secondary suturing,or free flap,or flap transfer at 5-7 days after primary operation. The therapeutic effects were evaluated by observing the wound healing,wound bacterial culture,healing time, recovery of limb function. Results:The wounds of 56 patients all healed. Fifty three patients had bone primary union,and 3 patients had delayed union. The average union time was 5.8 months. There was pin tract infection in 3 cases and superficial infection in 1 case. According to Ovadia evaluation criteria,45 patients got an excellent results,9 good and 2 fair. Conclusion: Artificial skin combined with external fixator is a simple and effective treatment method for Gustilo Ⅲtype severe open fractures of legs,which is effective to provide rapid fixation,seal wounds,and shorten secondary healing time of wounds.