LISS钢板治疗胫骨干复杂开放性骨折

Treatment Complicated Open Tibia Fracture with the Less Invasive Stabilization System

目的探讨LISS钢板治疗胫骨干复杂开放性骨折的疗效。方法对25例胫骨干复杂开放性骨折病例，GustiloⅢa型彻底清创后一期行LISS钢板联合封闭式负压引流，创面置管持续冲洗、创面用封闭式负压引流材料覆盖，接负压封闭式引流，GustiloⅢb型彻底清创后一期行外固定架固定，5—7d更换VSD材料，二期行LISS钢板固定骨折并植皮或行皮瓣转移术修复皮肤缺损。结果25例骨折24例骨性愈合，GustiloⅢa型19例行游离皮瓣及游离肌皮瓣，GustiloⅢb型4例行游离肌皮瓣转移术，2例行背阔肌皮瓣转移术。1例合并糖尿病发生软组织感染。结论在彻底清创的前提下VSD联合LISS钢板治疗GustiloⅢa、Ⅲb型胫骨干开放性复杂骨折是一种安全、有效的方法。

Objective To investigate the efficacy of the LISS plate in the treatment of complex open fractures in tibial shaft. Methods 25 eases of complex open tibial fracture were treated with the LISS plate. The patients of type Gustilo Ⅲa were treated with LISS plate and Vacuum sealing drainage（VSD） technique after thorough debridement. Then the wound was covered with suction drainage material, and continue to rinse and drainage. The patients of type Gustilo Ⅲb were fixed with ex- ternal fixator at the first stage. The VSD materials were replaced after 5 - 7 days, then the fractures was fixated with LISS plate at the second stage. The skin defects was repaired with skin grafts or flaps. Results Among the total of 25 patients, 24 patients obtained bony union. Nineteen patients of type Gustilo m a accepted free skin flap grafting or free myocutaneous flap grafting. Four patients of type Gustilo Ⅲb accepted free myocutaneous flap grafting, the remaining two patients received back rich myo- cutaneous flap transfering. There was only one patient suffered soft tissue infections due to diabete. Conclusion After the thorough debridement, VSD combined with LISS plate was a safe and effective treatment for Gustilo Ⅲa and Gustilo Ⅲb com- plex open fractures of tibial shaft.