组合式金属材料外固定支架治疗开放性胫腓骨骨折

Combined external fixators in treatment of open fractures of tibia and fibula

背景:开放性胫腓骨骨折的治疗难度在于既能保证骨折断端的稳定又能保护已遭受损害的残存血运,应用组合式外固定架治疗能够使患者在伤后及早恢复骨性结构,解决软组织损伤较重,污染严重不宜行内固定的难题。目的:观察组合式外固定支架治疗胫腓骨开放性骨折的临床疗效。方法:选择2005-03/2008-12天津市武清区人民医院骨科收治的胫腓骨开放性骨折患者28例,男22例,女6例,年龄23～61岁。均应用组合式外固定器治疗,观察创面愈合及膝、踝关节活动恢复情况;疗效评定标准采用Johner-Wruhs疗效分析法,并注意有无并发症发生。结果与结论:28例患者均获得随访,随访时间8～24个月。其中16例4～6个月达骨性愈合,8例8个月内达到骨性愈合,4例12个月内达到骨性愈合,无骨不连发生,肢体功能恢复满意。Johner-Wruhs评定优18例,良10例。提示应用组合式外固定支架治疗胫腓骨开放性骨折,能够达到早期复位,固定可靠,早期离床活动,减少该类骨折并发症的发生。

BACKGROUND： It is difficult to maintain fracture end stability or protect damaged blood transport in treating open fractures of tibia and fibula. Combined external fixators can early restore bone structures and attenuate soft tissue injury following fracture. OBJECTIVE： To observe the clinical efficacy of combined external fixators for open fractures of tibia and fibula. METHODS： A total of 28 cases of open fractures of tibia and fibula, including 22 males and 6 females, aged 23-61 years, were selected from People’s Hospital of Tianjin Wuqing District between March 2005 and December 2008. All patients were treated with the combined external fixator. The trauma healing and knee, ankle joint recovery, and complication were observed. The treatment effect was evaluated using Johner-Wruhs method. RESULTS AND CONCLUSION： The patients were followed-up for 8-24 months. There were 16 cases achieving bone healing in 4-6 months, 8 cases achieving bone healing in 8 months, and 4 cases within 12 months to achieve bone healing. No nonunion occurred, and limb functional recovery was satisfied. Johner-Wruhs evaluation was excellent in 18 cases and good in 10 cases. Results show that combined external fixators achieved an early fracture reduction, reliable fixation, early activities off the bed and reduced the incidence of complications of fractures in treating tibial and fibular open fractures.