腓骨内固定治疗中重度开放性胫腓骨折的随机对照分析

Randomized Controlled Analysis of Fibula Internal Fixation for Moderately Severe Open Fracture of Tibiofibula

目的探讨单纯腓骨内固定与钢板螺钉、交锁髓内钉、外固定架治疗中重度胫腓骨开放性骨折GustiloⅡ、Ⅲ型的临床疗效。方法选择2001年1月～2005年2月治疗180例Ⅱ、Ⅲ型开放性胫腓骨骨折,随机分为四组。比较各组的骨折愈合时间、患肢膝踝关节功能恢复的优良率、感染率、固定失效率、骨折延迟愈合及骨不连率。结果所有患者至少随访2年以上,腓骨骨折的愈合时间和膝、踝关节功能恢复的优良率(按Johner-Wruh标准评定),四组无统计学意义。在胫骨骨折的愈合时间单纯腓骨内固定组少于其他三组,有统计学意义。感染率方面单纯腓骨内固定组和交锁髓内钉组小于另外两组。固定失效率、骨折延迟愈合及骨不连率方面单纯腓骨内固定组少于其他三组,有统计学意义。结论对Ⅱ、Ⅲ型胫腓骨开放性骨折,单纯行腓骨内固定可简化手术,促进骨折早期愈合,减少各种并发症并且能获得较好的患肢功能。

Objective To compare the curative effects of the fibula internal fixation for treating Gustilo type Ⅱ, Ⅲ tibial and fibular open fracture with the plate internal fixation, interlocking intramedullary nail and external fixation frame.Methods The 180 patients with type Ⅱ, Ⅲ tibial and fibular open fracture were treated from 2001 to 2005. All the patients were divided into four groups randomly and were followed up for at least two years. After the treatment the average fracture healing time, the rate of excellent or good of the knee and the ankle joint （by Johner-Wruh criteria ）, the rate for the occurrence of complications such as the postoperative inflammation, the internal fixation failure and delayed union or nonunion were judged as clinical observation.Results In the treatment of tibial and fibula fracture, there were no significantly statistical differences in the healing time of fibula fracture, the rate of excellent or good function of the knee joint among four groups. The postoperative inflammation rate in fibular internal fixation group and interlocking intramedullary nail group was less than that in the other two groups. The healing time of tibial fracture and the rate for the occurrence of complications such as the internal fixation failure and delayed union or nonunion in only fibular internal fixation group were less than that in the other three groups. There were significantly statistical differences.Conclusion In the treatment of open tibial and fibula fracture the only fibular internal fixation can simplify the surgical procedures, promote the fracture healing, reduce the rate of complication occurrence and reach better recovery of joint function.