胫腓骨下段严重开放性粉碎性骨折的综合治疗

Combining Treatment of Severe Lower Tibia and Fibula Open Comminuted Fracture

目的探讨胫腓骨下段严重开放性骨折综合治疗。方法本科收治29例胫腓骨下段严重开放粉碎性骨折，采用早期跨关节外固定器固定结合有限内固定、创面清创、威克伤负压封闭引流，及后期转移皮瓣植皮等综合治疗方法。结果骨折临床愈合平均18周，Ⅱ期转移皮瓣均存活。优良率达90％以上。结论跨关节外固定器结合有限内固定及创面威克伤封闭灌洗，Ⅱ期皮瓣转移综合治疗是高能量致胫腓骨下严重开放粉碎性骨折首选和有效方法。

Objective To sum up the experience of the combining treatment of severe lower tibia and fibula open comminuted fracture. Methods From April 2004 to March 2006, 29 patients with lower tibia and fibula open comminuted fracture were receiving single-arm and spanning external fixator combining limit intermal fixation, debridement, wide area skin soft tissue defects treated by Vacuseal vacuum sealing drainage （VSD） and secondary deep fasciocutaneous flaps or muscletaneous flaps to soft tissue defects. The clinical outcomes and complications were investigated and the postoperative X-ray examinations of the ankle were also evaluated. Results All cases were followed up range from 6 to 30 months. All fractures were eventually healed, the average healing time of fracture was 18 weeks. While the X-ray pictures showed that one-stage union was achieved in 26 patients （89.6%）, delayed unions in 3 patients （10.4%）. No major complication occurred in all patients. The ankle function was evaluated according to the AOFAS scoring system, excellent in 16 patients （55.1%）, good in 12 patients （41.4%）, fair and poor in 1 patients（3.5%）. The excellent and good rate beyond 90%. In this group, 15 secondary flaps have all been alive, while 3 of them got delayed union after proper treatment. The following-up showed good function and shape, all the flaps remain alive. Conclusion The combining treatment is a safe and effective method in treatment of severe lower tibia and fibula open comminuted fracture.