摘要
目的 探讨外固定支架治疗GustiloⅡ、Ⅲ型胫腓骨开放性骨折的疗效.方法 回顾性分析2010年2月至2013年10月期间应用组合式或环型外固定支架治疗的76例胫腓骨开放性骨折患者资料,男48例,女28例;年龄为15～ 66岁,平均41.6岁;左侧40例,右侧36例.开放性骨折按Gustilo分型：Ⅱ型37例,ⅢA型28例,ⅢB型11例.39例患者采用组合式外固定支架固定,37例患者采用Ilizarov环型外固定支架固定.结果 76例患者术后获6～ 30个月（平均26个月）随访.所有患者骨折均获愈合,愈合时间为12 ～ 54周（平均22.6周）.1例Gustilo ⅢB型骨折患者因骨缺损4 cm而行干骺端截骨延长.15例患者二期行游离植皮,3例患者行带蒂皮瓣转移,1例患者行游离皮瓣转移.主要并发症：针道感染9例（25针）,骨髓炎2例,膝关节功能受限2例,踝关节功能受限4例,骨折延迟愈合3例.末次随访时按照Johner-Wruhs评分标准评定膝、踝关节功能恢复情况：优52例,良21例,差3例,优良率为96.1％;按照Merchant评分标准评定患者骨折处愈合情况：优42例,良26例,可6例,差2例,优良率为89.5％.结论 外固定支架治疗GustiloⅡ、Ⅲ型胫腓骨开放性骨折可以取得较好的临床效果,虽然操作复杂且有轻微并发症,但仍值得临床推广.
Objective To explore the clinical effects of external fixators on treating patients with open tibial fractures of Gustilo types Ⅱ ＆amp;Ⅲ.Methods From February 2010 to October 2013,76 patients with open tibial fractures were treated with emergency debridement and bone fixation using composite or circular external fixators.They were 48 males and 28 females,aged from 15 to 66 years（mean,41.6 years）.The injury affected the left side in 40 cases and the right side in 36.By the Gustilo classification,there were 37 cases of type Ⅱ,28 cases of type Ⅲ A and 11 cases of type Ⅲ B.Composite external fixators were used in 39 cases while Ilizarov circular external fixators in 37.Results All the patients were followed up for 6 to 30 months （mean,26 months）.All fractures united after an average time of 22.6 weeks （from 12 to 54 weeks）.Bone lengthening by metaphyseal osteotomy was performed in one case of Gustilo type Ⅲ B for a 4 cm bone defect.Secondary free skin grafting was performed in 15 patients.Transfer of pedicled skin flap was performed in 3 patients,and free skin flap transfer in one.The chief complications were pin tract infection in 9 cases（25 pins）,osteomyelitis in 2 cases,knee functional defection in 2 cases,ankle functional defection in 4 cases,and delayed union in 3 cases.By the Johner-Wruhs criteria for functional recovery of the knee and ankle at the last follow-up,52 cases were graded as excellent,21 as good and 3 as poor,giving a good to excellent rate of 96.1%.By the Merchant criteria for fracture healing,42 were graded as excellent,26 as good,6 as fair and 3 as poor,giving a good to excellent rate of 89.5%.Conclusions Application of external fixators to manage open tibial fractures of Gustilo types Ⅱ ＆Ⅲ can result in good clinical results.Although it is associated with technical difficulty and mild complications,it may be recommended for open tibial fractures,especially types Ⅱ and Ⅲ.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2014年第11期965-970,共6页
Chinese Journal of Orthopaedic Trauma
关键词
胫骨骨折
腓骨
骨折
开放性
外固定器
Tibial fractures
Fibula
Fractures,open
External fixators
