芦山地震中胫腓骨远端开放性骨折的治疗

Staged management of open distal tibiofibular fracture in Lushan earthquake rescue

目的总结地震灾害所致胫腓骨远端开放性骨折的特点，并探讨其治疗。方法2013年4月21Et至27日共收治12例地震伤所致胫腓骨远端开放性骨折伤员，男5例，女7例；年龄33～85岁（平均54．8岁）。开放性骨折按Gustilo分型：Ⅱ型5例，ⅢA型4例，ⅢB型3例。2例患者合并同侧膝关节闭合性骨折，3例患者合并内、外踝骨折。11例患者在急诊行清创、Hoffmann Ⅱ型组合式单边外固定支架固定，1例患者伤后5d行外固定支架固定。对于一期手术后下肢力线偏离、关节对应关系不佳及伴有踝关节脱位的患者，进行二期外固定支架调整。结果11例行急诊清创外固定支架固定术的患者中，4例下肢力线恢复满意，7例下肢力线恢复不满意。4例患者因软组织损伤较轻，拟近期更换内固定时直接调整下肢力线；另3例患者软组织损伤严重，且伴有内外踝骨折、踝关节脱位，行二期外固定支架调整术。此3例患者术后骨折均获得良好复位，下肢力线恢复满意，关节对应关系良好。结论组合式外固定支架可以快速、有效处理地震灾害中的胫腓骨远端开放性骨折。对于地震伤员，应尽可能一次将骨折复位及下肢力线固定好。对于复位不良者，应及时进行调整，以免因转运而影响治疗和最终功能。

Objective To characterize emergent treatment of open distal tibiofibular fractures in earthquake rescue in comparison with conventional medical treatment. Methods From 21 to 27 April, 2013, we treated 12 patients with open distal tibiofibular fracture who had been injured in the earthquake at Lushan, Yaan, Sichuan, China. They were 5 men and 7 women, aged from 33 to 85 years （average, 54. 8 years） . By the Gustilo classification, there were 5 cases of type Ⅱ, 4 cases of type ⅢA and 3 cases of type m B. Two patients were complicated with ipsilateral closed fracture of the knee. Emergent debridmnent and external fixation with Hoffmann assembled fixator were performed for 11 patients while one patient received external fixation 5 days after injury. Secondary correction of the external fixation was conducted for those with poor alignment or ankle dislocation after primary management. Results Among the 11 patients receiving emergent debridement and external fixation, 4 had satisfactory alignment of the lower limb but 7 did not. Of them, 4 with mild injury of the soft tissue received direct correction of the alignment of the lower limb when the external fixation was changed while the other 3 with severe injury of the soft tissue or with ankle dislocation or fracture received secondary correction of the external fixation. Good alignment, good fracture reduction and perfect congruence of adjacent joints were achieved in all patients. Conclusions Open distal tibiofibular fractures can be treated quickly and efficiently using an assembled external fixator in earthquake rescue. Initial restoration of the limb alignment and congruence of adjacent joints are crucial and secondary adjustment of the external fixation is necessary for those with poor reduction in case their final treatment and functional recovery. are affected by later transportation.