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吻合血管超长腓骨移植治疗胫骨严重粉碎性骨折 |
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刘兴炎 葛宝丰 甄平 高秋明 李旭升 刘占宏 王宏东
摘 要：目的 报告26例吻合血管的腓骨移植治疗胫骨粉碎性骨折及软组织损伤的临床经验。 方法 26例均为开放性骨折，属Hansen Ⅲ型骨折，其中多发伤14例。合并胫前和(或)胫后动脉损伤15例，合并胫后神经损伤6例，腓总神经损伤5例。26例中，16例Ⅰ期行吻合血管的超长腓骨或复合组织瓣移植，同时分别修复损伤的神经、血管及软组织，10例延期修复。 结果 术后随访6～24个月，26例胫骨骨折均骨性愈合，修复的血管、神经及肢体功能恢复良好，无一例发生感染。 结论 吻合血管的超长腓骨移植Ⅰ期或延期治疗严重的胫骨开放性粉碎性骨折，可促进骨愈合，降低感染及截肢率。
关键词：显微外科手术； 胫骨骨折，粉碎性； 骨移植，腓骨
Treatment of severe tibia syntripsis by overlength fibular
transplantation with vascular anastomosis
LIU Xingyan, GE Baofeng, ZHEN Ping， et al.
（Dept. of Trauma and Orthopedics, Lanzhou General Hospital, Lanzhou 730050, China）
Abstract：Objective To report clinical experience of treatment of severe tibia syntripsis and soft tissue injury by fibular transplantation with vascular anastomosis in 26 cases. Methods Of 26 cases of open tibia fracture which was one of Hansen Ⅲ tibia fractures, 14 cases were with multiple injuries, 15 with anterior tibia artery and/or posterior tibia artery injury, 6 with posterior tibia nerve injuries and 5 with common peroneal nerve injuries and. Of 26 cases, 16 cases were treated primarily with fibular or compositus tissue flap transplantation with vascular anastomosis; injured nerves,blood vessels and soft tissues were restored. Ten cases accepted delayed treatment. Results The follow-up for 6 to 24 months showed that all 26 cases with tibia fracture were cured. The repaired arteries, nerves, limbs and trunk returned to satisfactory function. None had infection. Conclusions Primary or delayed treatment of open tibia syntripsis by overlength fibular transplantation with vascular anastomosis can help fracture healing and decrease the rate of infection and amputation.
Key words：Microsurgery; Tibia fracture, comminuted; Bone transplantation, fibula▲
随着经济的不断发展，因各种高能暴力所造成的胫骨Ⅲ型骨折并非少见。国内外对此类骨折现有的处理方法，均难收到令人满意的效果。而采用显微外科技术重建此类复杂性骨折，修复其软组织损伤，能收到良好的疗效。
临床资料
一、一般资料
本组 26例，男 19例，女7例；年[1] [2] 下一页
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