单侧外固定支架治疗胫腓骨严重开放性骨折

Treatment of Severe Open Fractures of Tibia and Fibula with Unilateral External Fixation Apparatus

目的评价单侧外固定支架跨关节固定治疗胫腓骨不同部位严重开放性骨折的疗效及对关节功能的影响。方法对46例胫腓骨不同部位严重开放性骨折予以单侧外固定支架治疗,根据跨关节固定分为二组。A组18例骨折位于胫腓骨上段近膝关节部位,支架治疗需要跨膝关节固定。B组28例骨折部位位于胫腓骨远端,可涉及关节面,支架治疗需要跨踝关节固定。疗效及关节功能结果评定分为优、良、可、差四级。结果A组骨折愈合的优良率61.1%(11/18),其关节功能优良率88.9%(16/18);B组骨折愈合的优良率71.4%(20/28),其关节功能优良率89.3%(25/28);A组与B组之间的差异没有统计学意义(P>0.05)。结论单侧外固定支架对伴有软组织缺损的严重开放性胫腓骨骨折的治疗具有独特的优势,跨关节固定时,对关节功能有一定程度的影响。

Objective To evaluate retrospectively the outcomes of the treatment of severe open fractures in different zones of tibia and fibula with unilateral external fixation apparatus and affection to function of joints involved due to the treatment. Methods 46 cases suffered from severe open fractures in different zones of tibia and fibula after trauma from 1997 - 2004 with the use of unilateral external fixation apparatus were divided into 2 groups according to fixing across the joint involved. Group A included 18 cases with fractures near the knee joints and were managed by a fixing across the knee joint. Group B 28 cases with fractures near the ankle joints and the articular surface of which might be involved by a fixing across the ankle joint. The outcomes of both the treatment and the function of joints involved were graded into the excellent、the good、the fair and the poor. Results The rate of both the excellent and the good of the outcomes of the treatment in group A was 61.1% (11/18), in group B 71.4% (20/28) .The rate of both the excellent and the good of the outcomes of the function of joints involved in group A was 88.9 % (16/18), in group B 89.3 % (25/28) . The difference between group A and group B had not statistical significance ( P > 0.05 ) . Conclusion Unilateral external fixation apparatus is appropriate for treatment of severe open fractures of tibia and fibula, and could slightly affect the articular function when it is used to fix the bone across the joint involved.