胫骨开放性骨折的首诊治疗(附124例分析)

The Initial Diagnosis and Treatment of Open Fracture of Tibia With A 124-case Report

目的 探讨胫骨开放性骨折的首诊治疗。方法 对 12 4例胫骨开放骨折患者就首诊医院、骨折固定、伤口闭合进行分组回顾分析。结果 伤口深部感染与骨髓炎发生率均以钢板固定组最高 ,带锁髓内钉组与外固定支架 +有限内固定组最低 (P <0 0 0 1) ,弃拐负重与骨愈合时间以带锁髓内钉组最早 (P <0 0 5 ) ;伤口不同闭合方式的愈合时间无明显差异 (P >0 0 5 ) ,Ⅲ°损伤的伤口深部感染率以延期闭合组最低 (P <0 0 1)。结论 提高胫骨开放性骨折治疗优良率的关键在于提高首诊治疗的质量 ,其具体措施包括早期合理的清创与应用抗生素、伤口闭合与引流以及骨折固定方式的合理选择、一期植骨与早期截肢适应症的严格掌握等。带锁髓内钉固定与外固定支架

Objective To study the Initial diagnosis and treatment of open fracture of tibia. Methods 124 patients treated with different fixation and wound closing in different hospitals were studied retrospectively.Results The rates of deep wound infection and osteomyelitis were the highest in steel plate fixation group,the lowest in interlocking medullary nailing group with a limited fixation(P<0.001); the time of weight bearing and bone union was early in interlocking medullary nailing group(P>0 05); the healing time of different wound closing has no significant difference (P>0 05); the infection rate of deep wound Ⅲ degree was the lowest in delayed wound closing group. Conclusions It is key to improve the quality of the initial diagnosis and treatment,its measures are effective early stage debridement, the use of antibiotic, reasonable wound closing ,drainage,fixation, primary bone graft,bone plantation at phase Ⅰ and rigid selection of amputation; interlocking medullary nailing and external fixation stand with limited internal fixation are effective methods for the fixation of open fracture of tibia in the initial diagnosis and treatment.