外固定支架结合螺钉内固定治疗开放性胫腓骨骨折伴大面积软组织缺损15例

Treatment of Open Tibia-fibula Fractures Associated with Soft Tissue Defect with External Fixator Combined with Screw Internal Fixation:A Report of 15 Cases

目的探讨外固定支架结合螺钉内固定治疗开放性胫腓骨骨折伴大面积软组织缺损的临床效果。方法对15例开放性胫腓骨骨折伴大面积软组织缺损的患者行急诊清创,螺钉内固定合并外固定支架固定术,视伤口情况分别行一期或二期皮瓣移植、植皮手术修复创面。结果所有患者术后随访4～20个月,平均10个月,住院时间15～45d,伤口甲级愈合13例,乙级愈合2例,1例发生骨不连,1例出现螺钉松动。患者术后功能评定:优9例,良5例,优良率93.3%。结论外固定支架结合螺钉内固定术,既有利于骨折愈合、软组织修复、减少伤口深部感染率,又有利于功能的恢复,是治疗开放性胫腓骨骨折伴大面积软组织缺损的有效方法。

Objective To explore the clinical effect of external fixator combined with screw internal fixation on open tibia-fibula fractures associated with soft tissue defect.Methods Fifteen patients with open tibia-fibula fractures associated with soft tissue defect were treated with emergency debridement,external fixation and screw internal fixation.Primary or secondary skin grafting was performed according to wound condition.Results Patients were followed-up for an average of 10 months（range 4 to 20 months）.The hospital stay ranged from 15 to 45 days.Among the 15 cases,grade A healing occurred in 13,grade B healing in 2,nonunion in 1,and bolt loosing in 1.The excellent and good rate of postoperative function was 93.3%（excellent in 9 cases and good in 5）.Conclusion External fixator combined with screw internal fixation is benefit for fracture healing,soft tissue repairing and reducing deep wound infection.Therefore,it is an effective method for treating open tibia-fibula fractures associated with soft tissue defect.