有限内固定结合外固定架治疗重度开放性和(或)感染性胫骨骨折

Limited internal fixation combined with external fixator for severe open and(or) infected tibial fractures

目的：探讨有限内固定结合外固定架治疗重度开放性和（或）感染性胫骨骨折的临床效果。方法：对18例严重开放性骨扔槲8例感染性骨折病例，采用克氏针螺钉、螺钉、可吸收螺钉和钢丝等有限内固定结合单臂外固定支架固定的方法治疗，一期：阿搂缝合或转移皮瓣修复皮肤缺损13例，皮肤坏死后二期转移皮瓣修复皮肤缺损的5例。感染性骨折8例，同样有限内固定结合外固定支架固定的方法治疗骨折，直接通过换药伤口愈合的3例，通过转移皮瓣修复皮肤缺损的5例。结果：有23例获得了随访。随访时间6个月～3年。感染完全控制。X线显示13例达到解剖复位，7例达到基本解剖复位，3例复位较差。21例骨折愈合，2例骨折不愈合，不得不创面修复后再次植骨内固定。按Jolmer—Wruhs评分标准：优7例，良10例，可3例，差3例。结论：有限心固定加外固定支架既能提供骨折的稳定，又能避免因内植物过多导致感染的难以控制，是治疗严重开放性和（或）感染性胫骨骨折的良好选择。

Objective To prabe the effect of internal fixation combined with external fixator for severe open and （or） infected tibial fractu：es Method Total 18 severe open tibial fractures and 8 infected tibial fractures （ 16 male and 8 female） were treated with limited internal fixation combined with extenaal fixator. After the fractures were fixed with wires, screws, absorbed screws and external fixator, the defect of skin sutured immediately or repaired with transposition of flap. Results Total 23 cases got follow - up, and lasted for 6 - 36 months, and the infcction were totally controlled. The feractures of 21 cases were healed, and 2 cases ununioned were treated with internally fixation. The articrlar function was excellent in 7 cases, normal in 10,ok in 3, and disfunetioned in 3. Conclusion Limited internal fixation combined with external fixator is the good way for treatment of severe open and （or） infected tibial fractures.