支架外固定结合局部转移皮瓣修复伴皮肤软组织缺损胫腓骨开放骨折

【目的】探讨支架外固定结合局部转移皮瓣在修复伴皮肤缺损胫腓骨开放骨折中的应用。【方法】对38例胫骨或胫腓骨开放骨折伴皮肤缺损无法直接修复的患者（Gustilo ⅢB型、ⅢC型）采取急诊清创、外固定支架固定骨折，一期或二期局部转移皮瓣修复皮肤缺损，术后常规抗感染，对症处理，术后1周开始膝、踝关节保护性功能锻炼，术后4周开始扶拐下地负重。每隔4～6周复查一次X线片，骨折愈合拆除外固定支架。所有患者术后随访12～18个月。【结果】按照Johne-Wruhs评分标准，38例患者中34例患者骨折均达到临床愈合标准，皮肤缺损创面愈合良好，患肢功能基本恢复，2例患者皮瓣边缘部分坏死，经换药后瘢痕愈合，2例患者出现感染及骨髓炎、骨不连，后经抗感染、置管冲洗、感染控制后植骨等措施亦予以修复。【结论】支架外固定结合局部转移皮瓣手术修复胫腓骨开放骨折伴皮肤软组织缺损，可以减少骨折局部损伤，保护并改善局部血运，有效控制感染，促进骨折愈合，减少骨不连及骨髓炎的发生，临床效果满意，手术操作简单、不需借助特殊设备，值得推广应用。

External Fixation Combined with Local Flap in Repairing Open Tibia & Fibula Fractures with Skin and Soft Tissue Defects

Objective]To explore the application of external fixation combined with local flap in repairing open tibia or tibia ＆ fibula fractures with skin and soft tissue defects. Methods] Thirty eight patients suffered to open tibia ~ fibula fractures with skin and soft tissue defects （ Gustilo ⅢB, ⅢC ） which could not be sutured directly were given emergency debridement and external fixation, and repaired with local flap at the same time or for a second operation. After operation, routine anti-infection treatment and other orthopedic hospitalization were given. Protective exercise of the knee and ankle began at one week after operation. All the patients were advised to walk with crutches at 4 weeks after operation. Regular x-ray examination for every 4 - 6 weeks was performed. The external fixator was removed while the fracture was healed. All the patients were followed up for 12-18 months. Results] According to Johner-Wruhs assessment criteria,34 of the 38 tibia ＆ fibula fractures accorded with the standard of clinical healing and had complete healing of the skin defect and the recovery of the limb function. Among all patients, 2 patients had the necrosis of the marginal part of flaps and were cured after further treatment, 2 patients had infection, suppurative osteomyelitis and nonunion, and were cured by irrigation treatment and artificial bone grafting. Conclusion]The clinical efficacy of external fixation combined with local flap in repairing open tibia ＆ fibula fractures with skin and soft tissue defects is definite because it can effectively reduce the damage, protect the blood supply and control the infection, further to promote the fracture healing and reduce the incidence of nonunion. Moreover, this operation is easy to grasp and needs no special equipment, and is worthy of clinical application.