{"title":"同时内固定和背阔肌蒂皮瓣覆盖:一种治疗开放性骨折并伴有上肢大量软组织损失的可靠方案。","authors":"","doi":"10.1016/j.jos.2023.09.005","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p><span>The optimal treatment protocol for open fractures with accompanying sizable </span>soft tissue defect<span> of the upper extremities has not been specifically delineated. The authors described the concurrent use of internal fixation and latissimus dorsi (LD) pedicle flap coverage in managing such complex fractures.</span></p></div><div><h3>Methods</h3><p>Twenty patients with open fractures accompanied by large soft tissue defect of the upper extremities (8 clavicle fractures and 12 humeral fractures) were treated by fix & LD pedicle flap. The dimension of the defect, time to fix & flap, post-operative complications, time to union and clinical measurements were recorded.</p></div><div><h3>Results</h3><p>The mean size of the defect was 132.45 cm<sup>2</sup> (range 6–12 x 2–20 cm<sup>2</sup><span>). The average time to fix & flap was 9.9 days (range 7–14). Fractures union<span><span> was achieved in all patients with an average duration of 18.5 weeks (range 14–28). Regarding post-operative complications, distal flap necrosis occurred in 3 patients, retained </span>seroma<span> in 3 and heterotopic ossification in 1. By the Mayo Elbow Performance (MEP) score, 3 cases were considered to be excellent, 6 were good, 7 were fair and 4 were poor. By the University of California–Los Angeles (UCLA) shoulder score, 2 cases were considered to be excellent, 7 were good, 7 were fair and 4 were poor. The average Disabilities of Arm, Shoulder and Hand (DASH) score was 31.29 (range 12.5–58.3).</span></span></span></p></div><div><h3>Conclusion</h3><p><span>Fix & LD pedicle flap is a reliable regimen for open fractures with sizable soft tissue defect of the clavicle and </span>humerus.</p></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":null,"pages":null},"PeriodicalIF":1.5000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Simultaneous internal fixation and latissimus dorsi pedicle flap coverage: A reliable regimen for open fractures with accompanying sizable soft tissue loss of the upper extremities\",\"authors\":\"\",\"doi\":\"10.1016/j.jos.2023.09.005\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p><span>The optimal treatment protocol for open fractures with accompanying sizable </span>soft tissue defect<span> of the upper extremities has not been specifically delineated. The authors described the concurrent use of internal fixation and latissimus dorsi (LD) pedicle flap coverage in managing such complex fractures.</span></p></div><div><h3>Methods</h3><p>Twenty patients with open fractures accompanied by large soft tissue defect of the upper extremities (8 clavicle fractures and 12 humeral fractures) were treated by fix & LD pedicle flap. The dimension of the defect, time to fix & flap, post-operative complications, time to union and clinical measurements were recorded.</p></div><div><h3>Results</h3><p>The mean size of the defect was 132.45 cm<sup>2</sup> (range 6–12 x 2–20 cm<sup>2</sup><span>). The average time to fix & flap was 9.9 days (range 7–14). Fractures union<span><span> was achieved in all patients with an average duration of 18.5 weeks (range 14–28). Regarding post-operative complications, distal flap necrosis occurred in 3 patients, retained </span>seroma<span> in 3 and heterotopic ossification in 1. By the Mayo Elbow Performance (MEP) score, 3 cases were considered to be excellent, 6 were good, 7 were fair and 4 were poor. By the University of California–Los Angeles (UCLA) shoulder score, 2 cases were considered to be excellent, 7 were good, 7 were fair and 4 were poor. The average Disabilities of Arm, Shoulder and Hand (DASH) score was 31.29 (range 12.5–58.3).</span></span></span></p></div><div><h3>Conclusion</h3><p><span>Fix & LD pedicle flap is a reliable regimen for open fractures with sizable soft tissue defect of the clavicle and </span>humerus.</p></div>\",\"PeriodicalId\":16939,\"journal\":{\"name\":\"Journal of Orthopaedic Science\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2024-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Orthopaedic Science\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0949265823002646\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Orthopaedic Science","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0949265823002646","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
背景:开放性骨折伴上肢软组织缺损的最佳治疗方案尚未明确。作者描述了内固定和背阔肌(LD)蒂皮瓣覆盖在治疗此类复杂骨折中的同时使用。方法:对20例开放性骨折伴上肢大面积软组织缺损的患者(锁骨骨折8例,肱骨骨折12例)采用固定-LD蒂皮瓣进行治疗。记录缺损的尺寸、固定和皮瓣的时间、术后并发症、愈合时间和临床测量结果。结果:缺陷的平均大小为132.45 cm2(范围6-12 x 2-20 cm2)。固定和皮瓣的平均时间为9.9天(范围7-14)。所有患者骨折愈合,平均持续18.5周(范围14-28)。关于术后并发症,远端皮瓣坏死3例,残留浆膜瘤3例,异位骨化1例。根据Mayo肘关节功能(MEP)评分,3例为优秀,6例为良好,7例为一般,4例为差。根据加州大学洛杉矶分校(UCLA)的肩部评分,2例为优秀,7例为良好,7例一般,4例为差。平均臂、肩和手残疾(DASH)评分为31.29(范围12.5-58.3)。结论:固定-LD椎弓根瓣是治疗锁骨和肱骨软组织缺损的开放性骨折的可靠方案。
Simultaneous internal fixation and latissimus dorsi pedicle flap coverage: A reliable regimen for open fractures with accompanying sizable soft tissue loss of the upper extremities
Background
The optimal treatment protocol for open fractures with accompanying sizable soft tissue defect of the upper extremities has not been specifically delineated. The authors described the concurrent use of internal fixation and latissimus dorsi (LD) pedicle flap coverage in managing such complex fractures.
Methods
Twenty patients with open fractures accompanied by large soft tissue defect of the upper extremities (8 clavicle fractures and 12 humeral fractures) were treated by fix & LD pedicle flap. The dimension of the defect, time to fix & flap, post-operative complications, time to union and clinical measurements were recorded.
Results
The mean size of the defect was 132.45 cm2 (range 6–12 x 2–20 cm2). The average time to fix & flap was 9.9 days (range 7–14). Fractures union was achieved in all patients with an average duration of 18.5 weeks (range 14–28). Regarding post-operative complications, distal flap necrosis occurred in 3 patients, retained seroma in 3 and heterotopic ossification in 1. By the Mayo Elbow Performance (MEP) score, 3 cases were considered to be excellent, 6 were good, 7 were fair and 4 were poor. By the University of California–Los Angeles (UCLA) shoulder score, 2 cases were considered to be excellent, 7 were good, 7 were fair and 4 were poor. The average Disabilities of Arm, Shoulder and Hand (DASH) score was 31.29 (range 12.5–58.3).
Conclusion
Fix & LD pedicle flap is a reliable regimen for open fractures with sizable soft tissue defect of the clavicle and humerus.
期刊介绍:
The Journal of Orthopaedic Science is the official peer-reviewed journal of the Japanese Orthopaedic Association. The journal publishes the latest researches and topical debates in all fields of clinical and experimental orthopaedics, including musculoskeletal medicine, sports medicine, locomotive syndrome, trauma, paediatrics, oncology and biomaterials, as well as basic researches.