【摘要】：目的探討短縮再植結(jié)合肢體延長技術(shù)治療小腿中下段嚴(yán)重離斷傷的臨床療效和技術(shù)要點。方法 2009年4月—2016年5月,采用一期短縮再植二期延長技術(shù)治療小腿中下段離斷傷12例。其中男9例,女3例;年齡16~32歲,平均28歲。致傷原因:交通事故傷4例,重物砸傷6例,機器擠壓傷2例。受傷至就診時間為30 min~6 h,平均3 h 12 min。其中右小腿中下段完全離斷6例,左小腿中下段不全離斷4例,左踝關(guān)節(jié)平面完全離斷2例。肢體短縮4.0~12.5 cm,平均7.3 cm;再植術(shù)后1.5~8.0個月行肢體延長術(shù),延長時間1.7~5.3個月,平均3.1個月。結(jié)果 12例短縮再植后再延長均達到雙下肢等長,術(shù)后延長段骨礦化良好,骨斷端和延長骨段均達骨性愈合,愈合時間7~16個月,平均11.3個月。所有患者均獲隨訪,隨訪時間6個月~5年,平均2年5個月。膝關(guān)節(jié)活動范圍:過伸0~5°,平均3°;屈曲110~140°,平均120°。除2例踝關(guān)節(jié)融合外,其余患者跖屈15~45°,平均26°;背屈10~25°,平均15°。足底感覺恢復(fù)至S_3+4例,S_3 6例,S_2 2例。末次隨訪時根據(jù)Kofoed功能評定標(biāo)準(zhǔn)評價,獲優(yōu)7例,良3例,可2例。結(jié)論通過短縮再植結(jié)合肢體延長技術(shù)治療小腿中下段嚴(yán)重離斷傷,擴大了下肢離斷再植適應(yīng)證,降低了再植難度,治療更簡便有效。
[Abstract]:Objective to investigate the clinical effect and technical points of short replantation combined with limb lengthening in treating severe broken lower leg injury. Methods from April 2009 to May 2016, 12 patients with middle and lower leg amputation were treated with one stage shortening replantation and two stage lengthening technique. Among them, 9 cases were male and 3 cases were female, the age was 16 ~ 32 years old with an average age of 28 years. The causes of injury were traffic accident in 4 cases, heavy object injury in 6 cases and mechanical crush injury in 2 cases. The time from injury to consultation was 30 min~6 / h, with an average of 3 h / 12 min. Among them, 6 cases were completely amputated in the middle and lower segment of the right leg, 4 cases were incomplete amputation of the middle and lower segment of the left leg, and 2 cases had complete dissection of the left ankle plane. Limb lengthening was performed at an average of 1.5 ~ 8.0 months after replantation of 4.0m cm, (12.5 cm,), and the lengthening time was 1.710 months (mean 3.1months). Results all the 12 cases were lengthened to the same length of lower extremity after replantation. The bone mineralization of the lengthened segment was good. The bone healing time was 7 ~ 16 months (mean 11.3 months). All patients were followed up for 6 months to 5 years with an average of 2 years and 5 months. The range of knee joint motion was 5 擄(mean 3 擄) and 110 擄140 擄(mean 120 擄). Except for the fusion of ankle joint in 2 cases, the flexion of metatarsus was 1545 擄(mean 26 擄), and that of dorsal flexion was 1025 擄(mean 15 擄). The plantar sensation recovered to S _ S in 34 cases, S _ S in 36 cases, S _ 2 in 22 cases. According to Kofoed functional evaluation criteria, 7 cases were excellent, 3 cases were good and 2 cases were fair at the last follow-up. Conclusion the technique of shortening replantation combined with limb lengthening is more convenient and effective for the treatment of severe lower leg amputated injury. The indication of replantation of lower extremity is enlarged, the difficulty of replantation is reduced, and the treatment is more simple and effective.
【作者單位】： 鄭州仁濟醫(yī)院創(chuàng)傷骨科;
【基金】：鄭州市管城區(qū)科技計劃項目(GK201724)~~
【分類號】：R658.3

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