目的 探讨旋股外侧动脉降支Flow-through皮瓣联合微创经皮钢板固定技术（minimally invasive percutaneous plate osteosynthesis，MIPPO）于急诊治疗胫腓骨Gustilo IIIC型骨折的可行性及疗效。 方法 回顾性分析2019年10月~2020年9月我科收治的6例胫腓骨Gustilo IIIC型骨折患者，其中男5例，女1例；年龄24~54岁，中位年龄35岁；交通事故伤4例，摔伤1例，重物砸伤1例。肢体严重程度MESS评分：>7分2例，6~7分3例，<6分1例。患者均伴有皮肤软组织缺损，软组织缺损面积15 cm×7 cm~28 cm×12 cm，均急诊采用旋股外侧动脉降支Flow-through皮瓣联合MIPPO治疗。 结果 本组患者住院时间10~20 d，平均14.2 d。皮瓣均I期顺利成活。所有患者获随访，随访时间7~12个月，平均10.1个月，随访期间无骨感染、骨髓炎等并发症，骨性愈合时间7~9个月，平均8.3个月，皮瓣颜色、质地良好，供瓣区留有线状瘢痕，肢体外形良好，无痛、感觉恢复良好、可负重行走、无明显跛行。 结论 旋股外侧动脉降支Flow-through皮瓣联合MIPPO急诊治疗胫腓骨Gustilo IIIC骨折，新鲜创面解剖清晰，手术更为简便，可显著缩短治疗周期，减少并发症，利于肢体功能早期恢复。
Abstract
Objective To investigate the feasibility and efficacy of descending branch of lateral circumflex femoral artery Flow-through flap combined with minimally invasive percutaneous plate osteosynthesis (MIPPO) in the emergency treatment of Gustilo type IIIC fracture of tibiofibula. Methods A retrospective analysis was performed on 6 patients with Gustilo IIIC fractures of tibiofibula admitted to our department from October 2019 to September 2020, including 5 males and 1 female. The age ranged from 24 to 54 years, with an average of 35 years. Causes of injury: 4 cases of traffic accidents, 1 case of falling, 1 case of heavy objects. Limb severity score: more than 7 scores in 2 cases, 6-7 scores in 3 cases, less than 7 scores in 1 case. All patients were accompanied by skin and soft tissue defects with an area of 15 cm×7 cm to 28 cm×12 cm. All patients were treated with the flow-through flap of descending branch of lateral circumflex femoral artery combined with MIPPO. Results The hospitalization time of patients in this group was 10 to 20 days, with an average of 14.2 days. All flaps survived successfully in stage I. All patients were followed up for 7-12 months, with an average of 10.1 months. During the follow-up period, there were no complications such as bone infection and osteomyelitis, and the bone healing time was 7-9 months, with an average of 8.3 months. The skin flap was of good color and texture, and there were linear scars in the donor site. The limbs were in good shape and functional satisfaction (no pain, good sensory recovery, weight-bearing walking, and no obvious lameness). Conclusions The flow-through flap with the descending branch of lateral circumflex femoral artery combined with MIPPO in emergency treatment of Gustilo IIIC fracture of tibiofibula can significantly shorten the treatment period, reduce complications, clear fresh wound anatomy and simpler operation, which is conducive to the early recovery of limb function.
关键词
股前外侧皮瓣； /
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Flow-through皮瓣； /
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急诊； /
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内固定； /
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骨折； /
/
显微外科
Key words
Anterolateral thigh flap; /
Flow-through flap; /
Emergency; /
Internal fixation; /
Fracture /
Microsurgery technology
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基金
贵州省科技计划（黔科合平台人才[2020]5012）；省部共建协同创新中心项目[教科技厅函（2020）39号]
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