严重小腿损伤的中晚期修复

目的 探讨严重小腿损伤中晚期修复的方法及疗效.方法 对45例严重小腿损伤后出现并发症的患者,运用负压封闭引流技术治疗创面感染,显微外科方法治疗小腿软组织及骨缺损、骨小连,骨迁移技术修复大段胫骨骨缺损,关节松解或成形术改善膝踝关节功能.结果 45例患者中有41例获12-64个月(平均38个月)随访,全部组织瓣均成活,39例骨折愈合,2例并发慢性骨髓炎发牛病理性骨折.下肢功能评价:优20例,良15例,差6例,优良率为85.4%.结论 综合运用负压封闭引流技术、显微外科方法、骨迁移技术及关节松解或成形术修复中晚期严重小腿损伤,可以恢复小腿功能,降低致残率.

Repair of severe lower leg injury at middle and advanced stages

Objective To investigate the methods and therapeutic effects of repairing severe injury to the lower leg at middle and advanced stages. Methods Altogether 45 patients suffering from complications after severe leg injury were investigated. The infections were controlled with vacuum sealing drainage; soft tissue defects, bone defects and nonunion of fracture were treated with microsurgery; large tibial defects were repaired with bone transfer; functions of knee and ankle joints were improved with arthrolysis and arthroplasty. Results Forty-one patients were followed up for 12 to 64 (average, 38) months. All the transplanted flaps survived. Fractures healed in 39 cases, but pathological fractures occurred in 2 cases complicated with chronic osteomyelitis. The function of lower leg was rated as excellent in 20 cases, fine in 15 and poor in 6.with the excellent-to-good rate being 85.4%. Conclusion The severe lower leg injury at the middle and advanced stages can be repaired with a combination of vacuum sealing drainage, micmsurgery, bone transfer, arthrolysis and arthroplasty which can improve the function of the affected limb and decrease the rate of mutilation.