严重开放性胫腓骨骨折两种固定法的比较与选择

Comparison and Selection Between Two Methods For Treating the Severe Open Fracture of Tibia And Fibula

目的 :就钢板内固定与外固定架对严重开放性胫腓骨骨折的治疗结果进行比较分析。方法 :2 4 1例病人 ,共 2 56侧肢体 ,均为Ⅲ度胫腓骨骨折。用钢板内固定 1 74侧 ,用外固定架 66侧 ,一期截肢 1 6侧肢体。结果 :钢板内固定组一期创面感染率 1 2 .9% ,二期创面感染率 2 1 .0 5;外固定架组一期创面感染率 1 3.64% ,二期创面感染率 1 8.1 8%。两种固定法二期创面肉芽长满时间 ,钢板内固定组 (n =1 9) :3周以内 6例 ,占 31 .58% ,3周以上 1 3例 ,占 68.4 2 % ,外固定架组 (n =2 2 ) :3周以内 1 7侧 ,占 77.2 7% ,3周以上 5侧 ,占 2 2 .73%。钢板内固定组平均愈合时间 1 2 0± 8.4天 ,畸形愈合率 5.1 7% ;外固定架组平均愈合时间 1 80± 9.3天 ,畸形愈合率 1 8.1 8%。结论 :可一期闭合创面的严重开放性胫腓骨骨折 ,首选钢板内固定 ;不能一期闭合创面的严重开放性胫腓骨骨折 。

Objective To evaluate the treatment of severe open fracture of the tibia and fibula with internal plate fixation and unilateral multifunctional external fixation apparatus.Methods 241 cases with 256 fresh fractures were reviewed.All of them were type Ⅲ fracture of the tibia.174 fractures were treated with internal plate fixation (group IF) and 66 with unilateral multifunctional external fixation (group EF),16 cases were amputated in first stage.Results The cases of group IF had an infection rate of 12.90% in first stage and 21.05% in second stage,the average healing time was 120±8.4 days,deformity rate was 5.17%.The cases of group EF had an infection rate of 13.64% in first stage and 18.18% in second stage,the average healing time was 180±9.3 days,deformity rate was 18.18%.19 cases in group IF were observed about granulatios of wound,among them,6 cases showed a full granulation in three weeks and 13 afterthree weeks.But these iudexes in 22 cases of group EF were 17 vs 5.Conclusion The internal plate fixation is the fitting treatment for tibia fibula fracture with the wound which would be closed in first stage and the unilateral multifunctional external fixation apparatus for the cases with the wound which wouldn′t be closed in first stage.