小腿远端车祸伤的特点分析及临床意义
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摘要
目的探讨车祸所致小腿远端1/3损伤的特点及临床意义。方法回顾分析2013年9月至2018年9月我院收治的64例(71个肢体)小腿远端车祸伤患者的临床资料。患者均为小腿远端1/3以下骨折或关节脱位、软组织环形从骨折的远近端自骨膜、肌肉、深筋膜上撕脱,或伴有血管神经和骨肌肉的严重损伤。按软组织撕脱层面和面积将患者分为轻、中、重度损伤,采用相应的治疗方法。轻度损伤患者19例(20个肢体),采用清创、固定;中度损伤患者27例(30个肢体),采用局部穿支或游离皮瓣修复;重度损伤患者18例(21个肢体),15例采用股前外侧嵌合组织皮瓣移植。结果 64例患者(71个肢体)共43例行皮瓣覆盖创面,除2例出现部分坏死,其余患者均一期成活。1年后随访41例,其中轻度损伤4例,功能满意;中度损伤21例,有2例功能欠佳;重度损伤16例,1例双侧截肢,功能欠佳;其余患者均恢复日常生活和工作,平均骨愈合时间为(4.05±0.53)个月。结论小腿远端1/3车祸伤各有其特点,临床应根据其不同的特点采取相应治疗方法。
Objective To investigate the characteristics and clinical significance of 1/3 distal crus injury caused by traffic accident. Methods The clinical data of 64 patients(71 limbs) with distal crus injury by traffic accident admitted in our hospital from September 2013 to September 2018 were retrospectively analyzed. All patients had fracture or joint dislocation lower than 1/3 distal crus, soft tissue annular avulsion from distal and proximal and of periosteum, muscle and deep fascia, or severe injury of vascular nerves and muscles. According to the layer and area of soft tissue avulsion, the patients were divided into mild, moderate and severe injuries, and the corresponding treatment methods were adopted.Nineteen patients(20 limbs) with mild injury were treated with debridement and fixation. Twenty-seven patients(30 limbs)with moderate injury were treated with local perforator or free flaprepairment. There were 18 patients(21 limbs) with severe injury, 15 patients of them were given transplantation of anterolateral femoral chimeric tissue flaps. Results In 64 cases(71 limbs), 43 cases were covered by flaps, except 2 cases with partial necrosis, others survived in one stage. Forty-one cases were followed up one year later, there were 4 cases with mild injury, both of them had satisfactory functions. There were 21 cases of moderate injury and 2 cases had poor function. There were 16 cases of severe injury, 1 case underwent bilateral amputation with poor function. Other patients returned to daily life and work. The average time of bone healing was(4.05 ±0.53) months. Conclusion The 1/3 distal crus injuries caused by traffic accident have their own characteristics, corresponding therapies should be adopted according to their different characteristics.
Objective To investigate the characteristics and clinical significance of 1/3 distal crus injury caused by traffic accident. Methods The clinical data of 64 patients(71 limbs) with distal crus injury by traffic accident admitted in our hospital from September 2013 to September 2018 were retrospectively analyzed. All patients had fracture or joint dislocation lower than 1/3 distal crus, soft tissue annular avulsion from distal and proximal and of periosteum, muscle and deep fascia, or severe injury of vascular nerves and muscles. According to the layer and area of soft tissue avulsion, the patients were divided into mild, moderate and severe injuries, and the corresponding treatment methods were adopted.Nineteen patients(20 limbs) with mild injury were treated with debridement and fixation. Twenty-seven patients(30 limbs)with moderate injury were treated with local perforator or free flaprepairment. There were 18 patients(21 limbs) with severe injury, 15 patients of them were given transplantation of anterolateral femoral chimeric tissue flaps. Results In 64 cases(71 limbs), 43 cases were covered by flaps, except 2 cases with partial necrosis, others survived in one stage. Forty-one cases were followed up one year later, there were 4 cases with mild injury, both of them had satisfactory functions. There were 21 cases of moderate injury and 2 cases had poor function. There were 16 cases of severe injury, 1 case underwent bilateral amputation with poor function. Other patients returned to daily life and work. The average time of bone healing was(4.05 ±0.53) months. Conclusion The 1/3 distal crus injuries caused by traffic accident have their own characteristics, corresponding therapies should be adopted according to their different characteristics.
引文
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[10]陈雪松,徐永清,陈建明,等.GustiloⅢB、ⅢC型小腿及足踝部开放性骨折的一期修复与重建[J].中华创伤骨科杂志,2014,16(11):939-945.
[11]杨润功,张伟佳,郑晓勇,等.下肢严重皮肤撕脱伤的分型和处理对策[J].实用手外科杂志,2007,21(2):73-76,129.
[12] ZHENG X,ZHENG C,WANG B,et al.Reconstruction of complex soft-tissue defects in the extremities with chimeric anterolateral thigh perforator flap[J].Int J Surg,2015,26:25-31.
[2]王新宏,郑晓菊,王保山.四肢大面积组织缺损的显微外科修复[J].中华显微外科杂志,2009,32(5):436.
[3]顾立强.复杂性创面中负压封闭引流技术的应用[J].中华显微外科杂志,2014,37(3):217-218.
[4]郑晓菊,张忠,李海军,等.旋股外侧动脉穿支嵌合皮瓣在修复四肢复杂创伤中的应用[J].中华显微外科杂志,2013,36(2):115-118.
[5]陈武,黎忠文,袁华军.小腿及足部开放性骨折合并皮肤缺损的皮瓣修复[J].中华显微外科杂志,2013,36(5):505-506.
[6]成亮,柴益民.肢体皮肤撕脱伤的治疗进展[J].中国修复重建外科杂志,2010,24(6):758-760.
[7]王振海,邹宁,傅作侠,等.车轮辗压伤的力学分析[J].创伤骨科学报,1987,4(6):339.
[8] GUSTILO RB,MERKOW RL,TEMPLEMAN D.The management of open fractures[J].J Bone Joint Surg Am,1990,72(2):299-304.
[9]顾立强,朱庆棠,戚剑.开放性骨折改良Gustilo分型与保肢策略[J].中华显微外科杂志,2017,40(1):13-15.
[10]陈雪松,徐永清,陈建明,等.GustiloⅢB、ⅢC型小腿及足踝部开放性骨折的一期修复与重建[J].中华创伤骨科杂志,2014,16(11):939-945.
[11]杨润功,张伟佳,郑晓勇,等.下肢严重皮肤撕脱伤的分型和处理对策[J].实用手外科杂志,2007,21(2):73-76,129.
[12] ZHENG X,ZHENG C,WANG B,et al.Reconstruction of complex soft-tissue defects in the extremities with chimeric anterolateral thigh perforator flap[J].Int J Surg,2015,26:25-31.