几种固定方式急诊治疗多发伤合并胫腓骨开放性骨折的疗效分析

Four emergency fixation methods for multiple trauma patients combined with open tibiofibular fractures： a comparative study

目的比较四种固定方法早期固定开放性胫腓骨骨折对严重多发伤患者治疗和预后的影响。方法回顾性分析243例存在胫腓骨开放性骨折的严重多发伤患者（ISS≥16分）的资料，其中对胫腓骨骨折采用跟骨牵引加夹板治疗48例，带锁髓内钉治疗69例，钢板螺钉治疗54例，外固定支架治疗72例。从病死率、ARDS、脂肪栓塞综合征（FES）、MODS、ICU监护时间等近期指标，以及创面愈合时间、骨折愈合时间、关节功能恢复优良率、骨折并发症等远期指标，对比分析四种早期固定方法对骨折本身和多发伤治疗的疗效。结果带锁髓内钉治疗胫腓骨骨折在多项指标方面较其他固定方法为优（P〈0．05，0．01）。结论带锁髓内钉治疗严重多发伤并胫腓骨中段开放性骨折（Gustilo Ⅰ型、Ⅱ型和Ⅲa型），明显减少并发症发生率，术后骨折愈合较为理想。

[ Abstract ] Objective To compare the effects of four different emergency fixation methods for the open tibiofibular fractures on the treatment and prognosis of the multiple trauma patients. Methods A comparative study was carried out on the effect of four different early fixation methods on the fracture and the multiple trauma in aspects of the short-term indicators including mortality rate, acute respiratory dis- tress syndrome （ARDS）, fat embolism syndrome （FES）, multiple organ dysfunction syndrome （MODS）, ICU stay and the long-term indicators including wound healing time, fracture healing time, rate of joint function recovery and fracture complications in 43 multiple trauma patients. Results The locked intramedullary nail was better than the other fixation methods including the calcaneal traction, the gypsum external fixation and the internal fixation with steel plate and external fixation support in most in- dexes （P 〈 0.05,0.01 ）. Conclusion The locked intramednllary nail can significantly decrease the incidence rate of complications and obtain sound fracture healing for the patients with multiple trauma combined with open tibiofihular fractures （types Gustilo Ⅰ, Ⅱand Ⅲa）.