前臂及手部毁损性骨折治疗体会

【】目的:探讨前臂及手部毁损性骨折的早期修复及功能重建的手术方法及疗效。方法:对2010-2014年收治36例前臂及手部毁损性骨折进行急性修复及功能重建,根据毁损性骨折的分型₁,其中a2型12例,b2型10例,c2 型14例,所有创面采用脉冲冲洗器冲洗,骨折采用外固定支架、克氏针固定,一期修复神经、肌腱、血管,创面以VSD封闭。结果:术后随访10个月-24月,患肢功能都有不同程度的恢复,明显优于假肢,其中5例去除负压后创面直接缝合,伴骨骼、肌腱、神经外露者以皮瓣覆盖后治愈,浅表感染20例,经清创、换药、植皮后治愈,骨髓炎7例,经过去除死骨,换药及多次负压引流后治愈,骨折一期愈合18例,延迟愈合6例,骨缺损不愈合12例,经植骨内固定后愈合。结论：外固定支架、克氏针、脉冲冲洗器、VSD联合治疗开放性前臂及手部毁损性骨折,具有创伤小、清创彻底、减轻创伤后肿胀、降低感染率等优点,为功能恢复、骨折愈合及二期处理提供有利条件。

Treatment of the forearm and hand damage fracture.//Wang Yan-biao, Zhou Yu, Liu Li-feng, et al. Department of Orthopedics, the General Hospital of Jinan Military Commend, Jinan, China, 250031.

Abstract: Objective: To investigate the operation methods and curative effect for emergency repair and functional reconstruction of forearm and hand impairment. Method: From 2010 to 2014, 36cases of the forearm and hand impairment fracture in emergency repair and functional reconstruction, According to the impairment fracture1, A2 type 12cases,B2 type 10 cases, C2 type 14cases, All adopts pulse irrigator washing of the wound, Fractuers were treated with limited internal fixation by Kirschner-wire or with external fixation. Nerves, tendons, blood vessels in emergency repair,and the wound were closed with the VSD. Result: After 10-24months follow-up, Limb function has a different degree of recovery, is superior to artificial limbs, 5 cases after the removal of negative pressure wound directly suture, with bones and tendons, nerves exposed to cure after flap coverage, 20cases of Superficial infection , cured after debridement, dressing, skin grafts, 7case of osteomyelitis , cured after the removal of dead bone and repeated VSD treatment, 18 cases were primary healing of fracture, 6 cases of nonunion, 12 cases bone defects of nonunion, after internal fixation of bone graft healing. Conclusion: External fixator, Kirschner-wire, Medical Pulse Irrigator, the VSD combined treatment damaged open the forearm and hand fractures, has superiority of less trauma, debridement completely, reduce post-traumatic swelling and reduce the infection rate,which can provide favorable conditions for functional recovery, fracture healing and the second period operation.