延迟一期吻合血管腓骨或腓骨皮瓣治疗胫骨严重开放性粉碎性骨折

目的探讨延迟一期吻合血管腓骨或腓骨皮瓣治疗胫骨严重开放性粉碎性骨折的临床疗效。方法选取2005年6月至2007年6月于我院治疗的26例采用吻合血管腓骨或腓骨皮瓣治疗的胫骨严重开放性粉碎性骨折患者为观察组,其中GustiloⅢB型10例,ⅢC型16例,骨缺损长度5～11cm。在患者病情稳定后,于伤后4～12d行吻合血管腓骨或腓骨皮瓣治疗,自体腓骨长度8～15cm。以2003年6月至2005年5月20例行外固定支架治疗患者为对照组。结果所有患者随访6～40个月,平均28.3个月,观察组26例皮瓣全部成活,无截肢及慢性骨髓炎发生。复查X线照片显示：术后3～6个月移植腓骨愈合,术后12～24个月[平均（18.9±5.2个月）]以后,移植腓骨胫骨化,功能恢复的良好。观察组骨痂出现时间、骨折愈合时间显著少于对照组（P〈0.01）;观察组优良率为96.2%,显著优于对照组的85.0%（P〈0.01）;观察组并发症显著少于对照组（P〈0.01）。结论延迟一期吻合血管腓骨或腓骨皮瓣治疗胫骨严重开放性粉碎骨折,能加速骨折愈合,减少并发症,缩短病程,降低肢体伤残率。

Treatment of open severely comminuted fracture of tibia with delayed I-stage vascularized free fibular auto-graft

Objective To explore and discuss the clinical effects of delayed I-stage vascularized free fibular autograft in treatment of open severely comminuted fracture of tibia. Methods 26 cases treated with vascularized free fibular autograft for open severely comminuted fracture of tibia(Gustilo ⅢB 10 cases and ⅢC 16 cases) from Jun. 2005 to Jun. 2007 were chosen as the study group. The length of bone defects were 5～11 cm. Vascularized free fibular autograft were performed after stability of the patients’ condition(4～12 days after injury) ,with vascularized free fibular 8～15 cm. 20 cases undergoing external fixation from Jun. 2003 to May 2005 were selected as the control group. Results After follow-up for 6～40 months(28.3 months on average) ,26 flaps were all alive without amputation or chronic osteomyelitis. X-ray observation showed that fibular union happened 3～6 months after operation,and grafted fibular healed with tibia 12～24 months after operation(18.9±5.2 months on average) . Time of callus occurrence and fracture concrescence in the study group were shorten than that of the control group(P<0.01);The excellent rate were 96.2% and 85.0% in two groups respectively(P<0.01);The rate of complication in the study group was much lower than that in the control group(P<0.01) . Conclusion The application of delayed I-stage vascularized free fibular autograft in the treatment of open severely comminuted fracture of tibia can promote fracture union,decrease complication,shorten the course of the disease,and lower the rate of limbs disablement.