急诊经单一外侧入路治疗胫骨远端开放性骨折合并腓骨骨折

Emergency treatment of distal tibial open fracture combined with fibula fracture through single lateral approach

目的探讨急诊经单一外侧入路治疗胫骨远端开放性骨折合并腓骨骨折的方法和疗效。方法 36例胫骨远端开放性骨折合并腓骨骨折患者行急诊手术治疗,清创后经单一外侧入路腓骨接骨板内固定,胫骨有限内固定(必要时加用跨踝外固定支架),直接缝合或原位植皮闭合开放伤口,患肢石膏外固定。结果患者术后随访8～36个月(平均20个月)。34例患者(94.4%)骨折愈合,愈合时间3～18个月(平均5.8个月),其中5例(13.9%)为延迟愈合;2例患者(5.6%)骨不连。术后14例患者(38.9%)原开放伤口出现皮肤坏死,其中2例(5.6%)发生伤口感染。根据美国足踝骨科学会评分系统,踝关节功能恢复总体优良率为80.6%。结论急诊经单一外侧入路治疗胫骨远端开放性骨折合并腓骨骨折可有效复位并内固定骨折,促进骨折愈合。

Objective To evaluate the operative method and clinical outcomes of the emergency treatment of distal tibial open fracture combined with fibula fracture through single lateral approach. Methods Thirty-six patients with distal tibial open fracture combined with fibula fracture underwent emergency treatment.After emergency debridement,all patients were treated with plate fixation of fibular and limited internal fixation of tibia through single lateral approach,as well as span-ankle external fixation when necessary.The original open wounds were closed by direct suture or in situ skin graft after fracture fixation.The injured limbs were stabilized with plaster external fixation. Results Patients were followed up for 8 to 36 months(20 months in average).Thirty-four patients(94.4%) experienced fracture healing,with healing time of 3 to 18 months(5.8 months in average),and delayed union occurred in 5 patients(13.9%).Nonunion occurred in 2 patients(5.6%).Postoperative skin necrosis occurred in 14 patients(38.9%),among whom 2(5.6%) experienced wound infection.According to American Orthopedic Foot and Ankle Society clinical rating scales,the total excellent and good rate was 80.6%. Conclusion Emergency treatment of distal tibial open fracture combined with fibula fracture through single lateral approach is contributive to fracture reduction and fixation,and can promote the healing of fractures.