肌肉在开放性下肢骨折中的益处仍有待确定。这项研究比较了通过游离股前外侧(ALT)皮瓣或结合肌肉(ALT-股外侧肌/ALT-VL)的ALT皮瓣治疗的开放性胫骨骨折的统计学等效组。方法与结果:长庚纪念医院,台湾,2004-2008年,用游离ALT或ALT-VL皮瓣特异性重建开放性下肢骨折的49个游离皮瓣(38个开放性胫骨)。不愈合的危险因素:两组之间相当,在吸烟方面没有区别,类固醇,糖尿病,皮瓣时间和AO分类的软组织和骨损伤。愈合率的比较:在第3、6、9和12个月,胫骨骨折(RUST)的影像学愈合评分在组间没有差异。与不愈合显著相关的唯一因素是存在SPRINT试验定义的危重骨缺损,比值比14.4(95%CI1.36-131.5),与AO骨分类无关,皮瓣类型,合并症或皮瓣大小。患者报告的结果:ALT-VL组患者满意度提高(p=0.01,Cohen’sd=1.1)。功能结果(Enneking评分)无统计学意义,但ALT-VL组倾向于在功能和皮肤质量领域的重要性。结论:根据本研究的结果,可以得出结论,在骨折巩固方面,骨损伤程度(特别是严重缺损)比皮瓣选择更重要。肌肉不会改善工会,联合或深层感染的速度。然而,更好的PROM可能与包含骨折部位周围的肌肉有关。
The benefits of the muscle in open lower limb fractures remain to be determined. This
study compared statistically equivalent groups of open tibial fractures treated by free anterolateral thigh (ALT) flaps or ALT flaps incorporating muscle (ALT-Vastus lateralis/ALT- VL). Method and Results: Chang Gung Memorial Hospital, Taiwan, 2004-2008, 49 free flaps in open lower limb fractures (38 open tibial) were specifically reconstructed with free ALT or ALT-VL flaps. Risk factors for non-union: equivalent between the two groups, with no differences in smoking, steroids, diabetes, time to flap and the AO classification of soft tissue and bone injury. Comparison of union rates: no difference was noted between groups in the Radiographic Union Score in Tibial Fractures (RUST) at 3, 6, 9 and 12 months. The only factor significantly associated with non-union was presence of a SPRINT
trial defined \'critical\' bone defect with odds ratio 14.4 (95% CI 1.36 - 131.5), with no association with AO bone classification, flap type, comorbidity or flap size. Patient-reported outcomes: the ALT-VL group showed improved patient satisfaction (p = 0.01, Cohen\'s d = 1.1). Functional outcomes (Enneking score) were not statistically significant, but the ALT-VL group trended towards significance in function and skin quality domains. Conclusions: Based on the results of this
study, one can conclude that the degree of bone injury (specifically a \'critical\' defect) is of greater relevance than flap choice with regard to fracture consolidation. Muscle does not result in improvements to union, the speed of union or deep infection. However, better PROMs may be related to the inclusion of the muscle around the fracture site.