【摘要】 目的 探讨LISS钢板外置联合腓肠肌内侧头肌皮瓣治疗Gustilo Ⅲ型胫骨中上段开放性骨折合并软组织缺损的应用及疗效。方法选择2016年6月至2022年6月期间应用LISS钢板外置联合腓肠肌内侧头肌皮瓣治疗Gustilo Ⅲ型胫骨中上段开放性骨折合并软组织缺损22例患者，男12例，女10例；年龄16～76岁，平均（42.46±3.54）岁；其中Gustilo ⅢA型4例，ⅢB型16例，ⅢC型2例，软组织缺损面积4 cm×5 cm～25 cm×13 cm。所有外伤患者入院后急诊行清创术，Gustilo ⅢA及ⅢC型胫骨开放性骨折，一期使用外置LISS钢板固定6例；Gustilo ⅢB型开放性胫骨骨折一期简单行克氏针有限内固定或石膏外固定，二期外置LISS钢板固定16例，所有病例均二期行腓肠肌内侧头肌皮瓣转移覆盖骨外露创面，修复软组织缺损，对于皮瓣供区取同侧大腿中厚皮片游离植皮。术后随访时主要观察皮瓣成活、骨折愈合、患肢肌力等情况。结果术后随访6～18个月，平均（12.4±1.2）个月。本组22例胫骨中上段开放性骨折伴软组织缺损创面全部愈合，其中有2例因转移皮瓣部分浅表坏死，经清创植皮后创面愈合；所有骨折均达临床愈合，其中1例出现慢性骨髓炎，经积极治疗后骨折愈合。2例踝关节背伸功能部分受限，未出现明显足跖屈功能障碍等现象。结论 应用LISS钢板外置联合腓肠肌内侧头肌皮瓣治疗Gustilo Ⅲ型胫骨中上段开放性骨折合并软组织缺损的患者，外置钢板不仅能使骨折获得良好的复位及坚强的固定，同时为转移皮瓣提供稳定的环境，减少其容积，提高皮瓣的成活率，有利于创面的修复，促进骨折愈合，能获得良好的临床效果。更多还原

【Abstract】 Objective To explore the application and effect of external LISS plate combined with gastrocnemius medial cephalic myocutaneous flap in the treatment of Gustilo type Ⅲ open fracture of middle and upper tibia combined with soft tissue defect. Methods From June 2016 to June 2022,22patients(12 males and 10 females)were treated with Gustilo type Ⅲ open fracture of middle and upper tibia combined with soft tissue defect by external LISS plate combined with gastrocnemius medial cephalic muscle flap. The age ranged from 16 to 76 years old,with a mean of(42.46±3.54)years old. There were 4 cases of Gustilo type ⅢA,16 cases of type ⅢB,and 2 cases of type ⅢC. The soft tissue defect area was 4 cm×5 cm～25 cm×13 cm. All trauma patients underwent emergency debridement after admission,and 6 cases of type Gustilo type ⅢA and type ⅢC tibial open fracture were fixed with external LISS plate in the first stage. And 16 cases of type Gustilo type ⅢB tibial open fracture were simply treated with limited internal fixation with Kirschner wire or plaster external fixation in the first stage,and the second stage was treated with external LISS plate fixation. All cases were treated with gastrocnemius medial cephalic musculocutaneous flap transfer at the second stage to cover the bone exposed wound and repair the soft tissue defect. For the donor area of the flap,free skin grafting was taken from the middle thick slice of the ipsilateral thigh. The survival of skin flap,fracture healing and muscle strength of affected limb were observed during postoperative follow-up.Results The postoperative follow-up was 6 to 18 months,with an average of(12.4±1.2)months. In this study,all the open fractures of the middle and upper tibia with soft tissue defects were healed,among which 2 cases were healed after debridement and skin grafting due to partial superficial necrosis of the transferred flap. All fractures were clinically healed,including 1 case with chronic osteomyelitis,which was healed after active treatment. In 2 cases,ankle dorsiflexion function was partially limited,and no obvious plantar flexion dysfunction was found.Conclusion The application of external LISS plate combined with medial gastrocnemius muscle flap in the treatment of Gustilo type Ⅲ open fracture of middle and upper tibia with soft tissue defect can not only make the fracture obtain good reduction and strong fixation,but also provide a stable environment for the transfer flap,reduce its volume,improve the survival rate of the flap,and facilitate the repair of the wound. It can promote fracture healing and obtain good clinical results.更多还原