骨外固定加压治疗胫骨骨折内固定失败的疗效观察

Observation on the effectiveness of treatment with external compressive fixation after failed tibial internal fixation

目的:评估胫骨骨折内固定失败后骨外固定的疗效。方法:4 3例胫骨骨折内固定失败后采用骨外固定治疗。骨外交叉穿针时,伤口感染应先彻底清创,取出已松动内固定物。稳定性骨折可直接加压固定,不稳定性骨折可借助外固定器连接螺杆牵伸使骨周组织产生一定张力能维持骨折对位、对线,同时也将骨折达到稳定固定。小腿上段软组织缺损选用腓肠肌皮瓣或腓肠肌内侧头转位,中下段用邻近筋膜皮瓣覆盖。结果:4 3例中32例伤口Ⅰ期愈合(79% ) ,骨折愈合时间为4～6个月(平均5 5个月)。结论:骨外穿针骨折固定牢固,方法简便,对骨端血供干扰小,能早期功能锻炼,有利于骨愈合。同时,也便于术后对伤口观察和处理。

Objective:To evaluate the therapeutic effect of treatment with external compressive fixation after failed tibial internal fixation.Methods:Forty-three patients of failed internal fixation of tibial fracture were transferred to external fixation.Debride the infective wound and removed the loose internal fixator before bone cross-pining immobilization.Direct compression was applied in stable tibial fracture.While in unstable fracture,reduction and alignment were achieved through soft tissue tension produced by extraction of external fixator.The soft tissue defects of proximal leg was repaired with gastrocnemius musculocutaneous flap or transferring medial head of gastrocnemius.The defects in the middle and distal parts were covered with neighboring fascial flap.Results:Out of the forty-three patients,thirty-two were healed in the first term(79%).Bone healing time was 4 to 6 months(5.5 months in average).Conclusion:The external fixation is simple and effective,which provids stable fixation,least disturbance of blood supply and facilitated fracture healing,monitoring and treating the wounds dealing postoperation.