以高能创伤为主的小腿开放性骨折的治疗

Treatment of open fracture in legs of main factor by trauma of high energy

目的总结以高能量创伤为主要致伤因素的小腿开放性骨折治疗经验。方法回顾性总结分析小腿开放性骨折218例225肢临床资料。结果本组218例225肢按Gustio分型,Ⅰ型95肢,Ⅱ型78肢,Ⅲ型52肢,其中休克13例(5.9%),骨筋膜室综合征16例(7.1%),伤口Ⅰ期愈合者186肢(82.6%),骨折Ⅰ期愈合者179肢(79.6%),血管吻合术7例,术后肢体功能和劳动能力恢复者172肢(76.4%)。结论本组高能量创伤造成的高能骨折占多数,故应重视抗休克、抗感染和多发伤的处理,尽早清创闭合伤口,骨折固定以钢板内固定最多,将来交锁髓内钉的应用会越来越多。

Objective:To discuss the experience of treating open fracture in legs due to high energy trauma. Method: Retrospective analysis of 218 cases clinical material of open fracture in legs were induded. Result: There were 218 cases 225 limbs, according to Gustilo: type Ⅰ 95 limbs, type Ⅱ 78 limbs, type Ⅲ 52 limbs. Among them, there were shock in 13 cases (5.9%) compartment syndrome 16 cases ( 7.1% ). The wounds primary healing were 186 limbs (82.6%), the fractures union by first intention 179 limbs(79.6%), vascular anastomosis 7 cases, complete recovery of leg function and return to employment were 172 limbs(76.4%). Conclusion: In the group, most of them are due to fracture of high energy trauma. Careful to treat shock、 infection and multipe injury, early debridement close the wound. Fracture fixation is delt with compression plate in a great measure, intramedullary interlocking nail is used popularly.