远海作业渔民小腿绞扎开放性骨折的救治

Treatment of the twisted open fracture in calf of fishing population of high seas

目的 探讨远海作业渔民小腿绞扎开放件骨折救治特点及疗效观察。方法 总结2000年1月～2005年1月应用单侧多功能外固定架、钢板、交锁髓内钉等多种固定器材治疗渔民小腿绞扎伤92例。结果 经过10个月～4年（平均18个月）随访，创口一期愈合27例（29％），延期愈合48例（52％），伤口坏死17例（18％）；骨折愈合39例（42％），延期愈合31例（34％），骨不连19例（21％），骨髓炎3例（3％）。结论 渔民小腿绞扎伤系暴力损伤，软组织损伤严重，船上救治条件差，航行时间长，感染及骨不连发生率高。创口一期清创、皮瓣转移，早期骨折端外固定架固定治疗优于钢板、交锁髓内钉。

Objective To discuss the treatment and curative effect of the twisted open fracture in calf of fishing population of high seas. Methods From Jan. 2000 to Jan. 2005,92 fishing population of high seas with the twisted open fracture in calf were treated by single-side external fixation equipment,plate and interlocking intra-medullary nail. Results All cases were followed up for 10 months -4 ydars（average 18 months）. Primarily healed up in 27 cases,secondarily healed in 48 cases and necrosis of wound in 17 cases. Primarily bone-unioned in 39 cases,delayed bone-union were found in 31 cases and non-union in 19 eases. Osteomyelitis occurred in 3 cases. Conclusion The twisted open fracture in calf of fishing population of high seas have a high ratio of infection and bone non-union because of severe soft-tissue injury, poor curative condition in boat and a long period of navigation. The curative effect of primary debridement of the wound,flap transfer and external fixation equipment is better than that of the plate and interlocking intramedullary nail.