重度开放性胫腓骨骨折的治疗

The Treatment of Severe Open Fractures of the Tibia and Fibula

目的：作者对重度开放性胫腓骨骨折不同的治疗方法进行比较分析。材料与方法：本组１６７例，共１７５侧，均为新鲜Ⅲ度开放性胫腓骨骨折。一期截肢７侧，清创后行石膏固定或牵引治疗４１侧，内固定７９侧，穿针外固定４８侧。结果：石膏固定或牵引组感染率３０．７７％，有２侧因感染难以控制而截肢，骨折愈合率７５．６８％，平均愈合时间６．８个月，骨不连和畸形愈合等远期并发症５１．３５％。内固定组感染率２９．８７％，其中２侧因感染截肢，骨折愈合率７４．６７％，平均愈合时间７．１个月，远期并发症３４．６７％。外固定架组感染率１２．７７％，无一侧因感染而截肢，骨折愈合率８７．２４％，平均愈合时间９．２个月，远期并发症２３．４０％。结论：外固定架对Ⅲ度开放性胫腓骨骨折的治疗有独到之处。

Purpose: A retrospective study was done in order to evaluate the treatment of severe open fracture of the tibia and fibula. Materials and Methods: 167 cases with 175 fresh fractures were reviewed. All of them are type Ⅲ fractures of the tibia. Seven cases were amputated in first stage, 41 fractures were treated with cast and traction, 79 fractures with internal fixation, and 48 fractures with external fixation. Results and Conclusion: The cases treated with cast and bone traction had an infection rate of 30. 77 %, 2 of them were amputated because of refractory infections. The union rate is 75. 68 % with an average healing time of 6.8 months, and the rate of late complications including nonunion and deformity is 51.35%. The fractures treated with internal fixation had an infection rate of 29.87%, union rate 74.67%, average healing time 7.1 months, and the rate of late complications 34.67%. Of these, 2 cases were amputated because of infection. The cases treated with external fixation had an infection rate of 12.77%, union rate was 87.24%, average healing time was 9.2 months, late complications rate was 23.40%, none of them was amputated due to infection. Therefore, external fixation should be used as a desirable method in treating type Ⅲ open tibial and fibular fracture.