复杂胫腓骨骨折治疗方法的选择

Treatment of complex tibia and fibula fractures

目的探讨严重复杂胫腓骨骨折治疗过程中手术时机、方法及内固定物的选择。方法177例胫腓骨骨折(42C型)患者均为二期行手术治疗。一期以全身及局部情况恢复为主,骨折先予以外固定支架或跟骨结节牵引等暂时固定,待情况稳定后,二期采用微创技术对骨折予以交锁髓内钉(118例)或钢板(59例)内固定,术后不辅以其他外固定。结果所有患者均得到随访,时间6～36个月。伤口愈合可,骨折无延迟愈合、畸形愈合。骨折临床愈合时间:髓内钉组14～16周,钢板内固定组14～17周。根据Johner-Wruhs评分,优良率分别为94%(111/118)及86%(51/59)。结论掌握好手术时机,合理地选择内固定物,结合微创手术技术,是治疗严重复杂胫腓骨骨折手术成功的关键。

Objective To investigate the appropriate timing, methods and type of internal fixation of surgical operation in the treatment of severely complicated tibia and fibula fractures. Methods 177 cases of patients with tibia and fibula fractures received surgical operation in our department. All the fractures were treated with external fixation or calcaneal traction during early stage and later received second stage operation when the local and whole body conditions were improved. The operations were carried out with minimally invasive surgery technique, using the interlocking intramedullary nail （ 118 cases） or plate （ 59 cases） as the internal fixation. Results All the patients were followed up for 6 - 36 months. There were no wound problems or fractures nonunion or delayed union were found. The average clinical healing time for intramedullary nailing group was 14 - 16 weeks and plating group was 14 - 17 weeks respectively. The excellent and good rates were 94% （111/118 ）and 86% （51/59 ） respectively according to JohnerWruhs score. Conclusions The proper choices of timing, methods, type of internal fixation of surgical intervention, along with minimally invasive surgery technique, usually give good clinical results in the treatment of severely complicated tibia and fibula fractures.