三种固定方式治疗Gustilo Ⅲ A-B型开放性胫骨骨折的对比

Comparison of three fixation techniques for open tibial fractures of Gustilo type ⅢA-B

[目的]比较三种固定方式对GustiloⅢA-B型开放性胫骨骨折的治疗效果。[方法]回顾性分析2008年1月～2014年12月本院手术治疗的80例GustiloⅢA-B型胫骨开放性骨折患者。按治疗方法:27例采取髓内钉(UTN)一期内固定,22例接受锁定钢板(LCP)一期内固定, 31例接受外固定支架(UEF)固定。记录患者相关资料,按照Johner-Wruhs评定标准进行患肢功能评价。[结果]三组患者在创伤严重度评分(ISS)、伤口污染程度、Gustilo-Anderson分型、按骨科创伤协会OTA分型、伤口创面覆盖方式方面的差异无统计学意义(P>0.05)。手术时间和术中失血量依次为LCP组> UTN组>UEF组,三组间差异有统计学意义(P<0.05)。所有患者随访24～60个月,平均(36.37±10.96)个月。三组患者在深部感染、骨髓炎、截肢、术后6个月愈合不良和12个月不愈合发生率方面的差异无统计学意义(P>0.05)。临床骨愈合时间三组间的差异无统计学意义(P>0.05)。末次随访时,按照JohnerWruhs评定标准评定优良率,UTN组为85.19%,LCP组为81.82%,UEF组为67.74%。[结论]在严格清创、结合置管冲洗和VAC的前提下,GustiloⅢA-B型胫骨开放性骨折采用Ⅰ期内固定方式治疗可以获得满意疗效。

[Objective] To compare clinical outcomes of three fixation techniques for Gustilo type Ⅲ A-B open tibial fracture. [Methods] A retrospective study was conducted on 80 patients who were surgically treated for Gustilo type Ⅲ A or B open tibial fractures from January 2008 to December 2014 in our hospital. In term of fixation applied, the fractures were fixed at one stage with locking compression plate(LCP) in 27 patients, unreamed tibial nail(UTN) in 22 patients, and unilateral external fixator(UEF) in the remaining 31 patients. The related clinical data were compared among the 3 groups, and the clinical outcomes were assessed by Johner-Wruhs criteria. [Results] There were no significant differences among the 3 groups regarding to injury severity score(ISS), wound contamination severity, Gustilo-Anderson classification, Orthopedic Traumatology Association(OTA) classification, and approaches of wound coverage(P<0.05). The operation time and intraoperative blood loss were ranked in the sequence of LCP > UTN > UEF with significant differences among them(P<0.05). The patients were followed up for 24to 60 months with a mean of(36.37±10.96) months. No significant differences were found in complications among them, such as deep infection, osteomyelitis, amputation,poor healing at 6 months and non-union at 12 months(P>0.05), and no a significant difference was proved either in fracture healing time among them(P>0.05). At the latest follow up, the excellent and good rate of clinical outcomes was85.19% for the UNT, 81.82% for the LCP and 67.74% forthe UEF based on Johner-Wruhs criteria. [Conclusion] Primary internal fixations do achieve sound clinical outcomes for Gustilo type Ⅲ A-B open tibial fractures provided that strict debridement, proper irrigation and vacuum sealing drainage(VSD) were performed.