Gustilo IIIB开放性胫骨远端骨折诱导膜技术后延迟重建带蒂穿孔肌皮瓣。

Zeitschrift fur Orthopadie und Unfallchirurgie Pub Date : 2024-10-01 Epub Date: 2023-09-22 DOI:10.1055/a-2151-5175
Shuming Ye, Neng Jin, Jian Sun, Liqian Zhang, Jisen Zhang, Juehua Jing
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引用次数: 0

摘要

本研究旨在评估诱导膜技术后延迟重建穿支蒂螺旋桨皮瓣治疗Gustilo IIIB开放性胫骨远端骨折的安全性和有效性,并评估两种不同穿支蒂桨状皮瓣的临床疗效和并发症。回顾性分析2017年5月至2022年3月采用诱导膜技术和延迟重建两种不同的穿支椎弓根螺旋桨皮瓣治疗的34例Gustilo IIIB开放性胫骨远端骨折患者。根据不同类型的带蒂穿支螺旋桨皮瓣,将患者分为两组。这次行动需要两个阶段。胫骨骨折放射学联合评分(RUST)用于评估胫骨缺损的愈合情况。美国足踝矫形学会(AOFAS)评分用于评估踝关节功能。记录了与该技术相关的并发症。PAPF组的连续清创次数(不包括在紧急和最终手术期间进行的清创次数)平均为2.28±0.83。PAPF组的平均骨缺损长度为6.76±0.69 cm,中位愈合时间为13.11±0.96个月,RUST评分为12.68±1.63,AOFAS评分为84.12±6.38。另一方面,PTAPF组的平均骨缺损长度为6.73±0.95 cm,中位愈合时间为12.63±1.46个月,RUST评分为13.73±1.53,AOFAS评分为82.79±5.49。两组在连续清创次数、骨缺损长度、骨愈合时间、RUST评分或AOFAS评分方面无显著差异(p>0.05)。PAPF组的皮瓣大小为9×6cm2至14×7cm2,PTAPF组为9×7cm2至13×7cm2。没有严重并发症,如皮瓣相关并发症或截肢。两组并发症的差异无统计学意义。在严重开放性胫骨骨折的情况下,重建方法很重要。当延迟重建不可避免时,外科医生应首先进行彻底清创术,然后进行真空密封引流作为桥接治疗;PAPF和PTAPF都可以被考虑用于确定的软组织覆盖。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Delayed Reconstruction of the Perforator Pedicle Propeller Flap after the Induced Membrane Technique for Gustilo IIIB Open Distal Tibial Fracture.

This study aimed to evaluate the safety and efficacy of delayed reconstruction of the perforator pedicle propeller flap after the induced membrane technique in the treatment of Gustilo IIIB open distal tibial fracture, and to evaluate the clinical outcome and complications of two different perforator pedicle propeller flaps.Thirty-four patients with Gustilo IIIB open distal tibial fractures treated by the induced membrane technique and delayed reconstruction of two different perforator pedicle propeller flaps from May 2017 to March 2022 were retrospectively analyzed. Patients were divided into two groups according to the different kinds of perforator pedicle propeller flaps covered. The operation required two stages. The Radiographic Union Score for Tibial fractures (RUST) was used to evaluate the healing of the tibial bone defect. The American Orthopaedic Foot and Ankle Society (AOFAS) score was used to evaluate ankle function. The complications associated with the technique were recorded.The number of serial debridements, excluding those performed during emergency and final operations, was a mean of 2.28 ± 0.83 in the PAPF group. The PAPF group had a mean bone defect length of 6.76 ± 0.69 cm, the median healing time of 13.11 ± 0.96 months, RUST score 12.68 ± 1.63, and AOFAS score of 84.12 ± 6.38. On the other hand the PTAPF group's mean bone defect length was 6.73 ± 0.95 cm, the median healing time 12.63 ± 1.46 months, RUST score 13.73 ± 1.53 and AOFAS score 82.79 ± 5.49. There were no observed significant differences the two groups in the number of serial debridements, bone defect length, bone union time, RUST score, or AOFAS score (p > 0.05). Flap size ranged from 9 × 6 cm2 to 14 × 7 cm2 in the PAPF group and from 9 × 6 cm2 to 13 × 7 cm2 in the PTAPF group. There were no severe complications such as flap-related complications or amputation. The differences in complications in the two groups were not statistically significant.In cases of severe open tibial fracture, the reconstructive method is important. When delayed reconstruction is inevitable, surgeons should first perform radical debridement, followed by vacuum sealing drainage as a bridging therapy; both PAPF and PTAPF can be considered for definitive soft tissue coverage.

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