闭合复位或有限切开外固定架治疗胫骨干骨折疗效评价

The evaluation for the therapeutic effect of closed reduction or limited open reduction and external fixation on tibial fracture

目的 评价外固定架治疗胫骨干骨折术后的疗效。方法 1993年至 2 0 0 2年在我院治疗的5 60例 5 82个胫骨干骨折 ,其中双胫骨干 2 2例 ,采用单边外固定架闭合复位或必要时结合有限切开有限内固定。结果 5 18例 5 3 4个胫骨干得到随访 ,随访率 92 .5 % ,随访时间 6～ 2 8个月 ,平均 14个月。外固定架使用时间 3d～ 18个月 ,平均 6个月。随访的 5 18例患者 ,骨折Ⅰ期愈合 462例 ,愈合时间平均 6.5个月 ,延迟愈合 48例 ,行自体骨移植术 ,其中 14例更换交锁髓内钉内固定。 6例伴有神经血管损伤 ,1周后截肢。 2例因筋膜室综合征 ,肌肉广泛坏死 ,半年后截肢。 15 5例开放骨折中 8例局部感染。 2 2例针道感染、针道松动 19例。结论 应用单边外固定架闭合复位或有限切开有限内固定治疗胫骨干骨折 ,简单 ,创伤小 ,感染率低 ,愈合率高 ,骨折愈合后去除外固定简单。通过加强护理 ,可以避免针道感染松动。

Objective To evaluate the efficacy of the treatment method of tibial fracture by external fixation.Methods From 1993 to 2002,560 patients with tibial fracture including 22 patients with double-side tibial fracture were treated by the therapy.There were 582 cases of tibial fractures totally.They were treated by closed reduction or limited open reduction and external fixation.Results 92.5% of these patients (518 cases,534 tibial fractures) were followed up from 6 to 28 months (mean 14 months).External fixator was used from 3 days to 18 months (mean 6 months).462 cases got primary union (mean 6.5 months).48 cases got delayed union and accepted bone graft.14 cases had to accept amputation within 1 week.2 cases who were associated with compartment syndrome had to accept amputation within half a year.Among 155 cases of open fracture,8 cases had local infection,22 cases had needle-path infection,19 cases had needle loosening.Conclusion The treatment method of tibial fracture with closed reduction or limited open reduction and external fixation has the advantage of simplicity,limited trauma,low infection rate and high union rate,and the external fixation is ease to be removed after fracture healing.The infection and loosening of the needle-path can be prevented by intensive care.