寒冷干燥环境下羊肢体枪伤骨折钢板内固定的实验研究

Internal plate fixation for limb gunshot fractures in cold and dry environment in sheep

目的观察寒冷干燥环境下羊肢体枪伤骨折后不同时间采用钢板内固定的疗效。方法选取新疆绵羊15只，处于-25℃寒冷干燥环境下3h后，以7．7式手枪枪击一侧小腿，致胫骨中段骨折。根据伤后处理时间的不同，将其分为6、12和24h处理三组，每组5只羊，分别于伤后6、12、24h行伤口清创、骨折钢板内固定，然后通过大体观察伤口愈合情况。采用单因素方差分析比较三组伤口愈合时间；通过x线片及病理观察骨折愈合情况。结果术后15只动物伤口愈合均良好，术后早期三组均有个别动物伤口出现红肿，12h和24h处理组个别动物伤口有少量分泌物，但均未形成感染。6、12、24h处理组的伤口愈合时间分别为（5．20±0．44）、（5．60±0．55）、（6．00±0．71）d，三组之间差异无统计学意义（F=2．40，P〉0．05）。X线片示三组骨折对线对位均良好，术后12周骨折线基本消失。术后12周病理观察三组均无骨髓炎表现，骨生长良好。术后6h处理组骨重建与骨塑形最快，24h处理组最慢。结论寒冷干燥环境下肢体枪伤后6～24h，伤道清创后骨折可以采用钢板内固定、一期闭合伤口，且越早越好。

Objective To observe the effects of internal plate fixation applied at different times to treat limb gunshot fractures in cold and dry environment in sheep. Methods Fifteen sheep were kept in cold and dry environment （ - 25 ℃ ） for 3 h. A fracture of the middle tibia at one side of hind limb was created by gunshot in each of the sheep. The sheep were evenly divided into 3 groups, for which the wound was debrided and internal plate fixation was applied 6, 12 and 24 h after the injury respectively. The wound condition and fracture healing were observed. Results In all the sheep, the wound healed well and no infection occurred. The healing time for the 3 groups was respectively （5.20 ± 0.44）, （5.60 ± 0. 55） and （6. 00 ± 0.71 ） d, without significant difference （ F = 2. 40, P 〉 0.05） . X-ray showed fine alignment of fracture. The fracture line almost disappeared 12 weeks later. Pathological observation 12 weeks after injury revealed fine new bone formation without any sign of osteomyelitis in the 3 groups. Bone reconstruction and moulding were the fastest in the 6 h group and the slowest in the 24 h group, Conclusions Limb gunshot fractures can be treated in cold and dry environment by internal plate fixation and primary wound closure after debridement. The appropriate treatment time ranges from 6 to 24 hours after the injury, and the earlier, the better.