一期植骨加内固定治疗手部开放性骨缺损

目的探讨应用一期植骨加内固定治疗手部开放性骨缺损的手术疗效。方法2000-2003年治疗手部开放性骨缺损12例；急诊采用彻底清创，自体髂骨植骨加钢板或克氏针内固定术治疗。其中7例因伴有皮肤软组织缺损同时行皮瓣移植术。结果11例创面I期愈合，其中6例皮瓣完全存活；1例皮瓣远端部分坏死，钢板外露，经皮瓣提升覆盖创面处理后愈合。术后随访1-3年，骨折愈合时间为2-6个月，平均3.5个月。手功能按TAM评定，优良率达82%。结论一期植骨加骨固定治疗手部开放性骨缺损能缩短病程，防止指体短缩，有利于手功能的恢复，彻底清创和良好的创面覆盖是手术成功的关键。

Primary bone grafting and internal fixation of open fracture and bone defect of the hand

Objective To discuss the treatment experience and outcome of bone grafting and internal fixation immediately in open fractures with bone loss of the hand. Methods From 2000 to 2003, 12 cases with open fractures of the hand associated with bone loss were treated immediately by iliac corticocancellous bone grafting. 7 cases of this series had associated soft tissue defects and were treated with simultaneous flap coverage. All cases were followed for 1 to 3 years. Results Primary healing of the wounds was achieved in 11 cases. 6 of the 7 flaps survived. Distal necrosis of the flap and plate exposure was seen in 1 case which was managed by debridement and flap advancement. Bone union of roentgenographic evidence was seen at 2 to 6 months postoperatively, with an average of 3.5 months. According to functional evaluation of TAM scales, the excellent and good rate was 82%. Conclusion The advantages of the technique are primary bone healing, a short rehabilitation period, and avoidance of wound contracture. Thorough debridement and secure soft-tissue coverage are most important to the success.