重度开放性胫腓骨骨折固定方式的临床评价

A comparative study of fixation instruments in the treatment of severe open fractures of tibia and fibula

目的 通过对不同固定方式治疗重度开放性胫腓骨骨折的临床结果进行比较 ,评价合理的固定方式。 方法 本组 12 1例、12 9侧肢体 ,均为新鲜Ⅲ度开放性胫腓骨骨折。Ⅰ期截肢5侧 ,清创后行石膏固定或骨牵引者 2 8侧 ,内固定 42侧 ,单侧外固定支架固定 5 4侧。 结果 石膏固定或骨牵引组 2 8侧 ,骨折愈合率 78.6 % ,平均愈合时间 7.3个月 ;浅表感染率、深部感染率分别为 2 1.4%和 2 5 .0 % ;远期并发症 6 0 .7%。内固定组 42侧 ,于术后 8h死亡 1例 ,骨折愈合率80 .0 % ,平均愈合时间 8.1个月 ;浅表感染率、深部感染率分别为 12 .2 %和 31.7% ;延期截肢 1例 ,远期并发症 45 .0 %。外固定支架组 5 4侧 ,延期截肢 1例 ,骨折愈合率 90 .6 % ,平均愈合时间 8.9个月 ;浅表感染率、深部感染率为 13.2 %和 7.5 % ;远期并发症 2 2 .6 %。 结论 外固定支架在治疗重度胫腓骨开放骨折中能达到有效固定、减少深部感染率。

Objective A retrospective study was made in order to e valuate the effective fixation instruments in the treatment of severe open fracture of tibia and fibula. Methods A total of 121 cases with 129 f resh fractures were reviewed. They were all type Ⅲ fractures of tibia. Five fra ctures were amputated at the first stage, 28 fractures treated with cast and tra ction, 42 fractures treated with internal fixation, and 54 fractures treated wit h unilateral external fixation. Results The fractures treated wi th cast and bone-traction had an union rate of 78.5% with an average healing ti me of 7.3 months. Superficial and deep infection rate was 21.4% and 25.0% re spectively. The rate of long term complications was 60.7%. In 42 fractures treat ed with internal fixation one case died 8 hours after operation, with an union r ate of 80% with an average healing period of 8.1 months. Superficial and deep in fection rate was 12.2% and 31.7% respectively; 1 case was amputated with a long -term complication rate of 45.0%. The fractures treated with external fixation had an union rate of 90.6% with an average healing period of 8.9 months. Superfi cial and deep infection rate was 13.2% and 7.5% respectively; and rate of lo ng-term complication was 22.6%. Conclusions External fixation can gain effective fixation, de crease the deep infection rate and is helpful for rapid rehabilitation in treati ng type Ⅲ open fractures of tibia and fibula.