创伤晚期胫骨缺损的病例回顾分析

A retrospective analysis of patients with late traumatic tibial defect

目的 了解创伤晚期胫骨缺损的诱因、易感人群及多次手术的原因,以期提出有效的预防措施.方法 回顾性分析2009年3月至2013年3月期间采用骨搬运术治疗的创伤晚期胫骨缺损患者资料,设计表格,收集并统计相关数据,对患者一般情况、受伤情况及治疗情况加以分析.结果 共统计94例胫骨缺损患者,男86例,女8例,男女比为10.8∶1.患者来自20个省、自治区及直辖市,其中56.4％ （53/94）来自河北省、内蒙古自治区和辽宁省;患者主要为体力工作者;交通伤是主要致伤原因;患者以21 ～ 50岁年龄段为主,占78.7％ （74/94）.开放性损伤占93.6％ （88/94）,54.3％（51/94）的患者存在合并伤.首诊医院以三级甲等医院及二级甲等医院为主.伤后6h内就诊者占72.3％ （68/94）.对于GustiloⅢC型胫骨开放性骨折,首诊手术仍有31.3％ （5/16）的患者采用内固定治疗.行骨搬运术前平均手术次数为（4.4±3.1）次.治疗费用平均为（16.1±9.9）万元,有61.7％ （58/94）的患者自费.结论 胫骨开放性骨折的主要致伤原因是交通伤,其晚期胫骨缺损的治疗非常棘手,骨科医生应重视正确掌握开放性骨折的治疗原则,提高治疗水平.

Objective To analyze the causes for injury and secondary surgery and susceptible population of late traumatic tibial defect.Methods The patients who had been treated for late traumatic tibial defect with bone transport using Orthofix Limb Reconstruction System （LRS） from March 2009 to March 2013 were retrospectively studied.The clinical data including general information,injury conditions and treatment were collected and analyzed statistically.Results Altogether 94 patients with late traumatic tibial defect were included.They were 86 men and 8 women,giving a male to female ratio of 10.8∶ 1.They came from 20 different provinces.56.4% of them （53/94） came from Inner Mongolia Autonomous Region,Hebei and Liaoning provinces.Most patients were physical laborers.Most injuries were caused by a traffic accident.78.7% of the patients（74/94） were aged from 21 to 50 years old.93.6% of the injuries （88/94） were open,and complicated injuries occurred in 54.3% of the patients（51/94）.Their original hospitals were mostly major medical institutions.72.3% of the patients （68/94） had had their injury treated within 6 hours posttrauma.31.3% of the tibial open fractures of type Gustilo Ⅲ C （5/16） were primarily treated with internal fixation.The operations before bone transport averaged 4.4 ± 3.1 times and cost of treatment 161,000 ± 99,000 Yuan.61.7% of the patients（58/94） paid their medical expenditures by themselves.Conclusions Traffic safety is of great importance for prevention of a late traumatic tibial defect.It is very challenging to treat late traumatic tibial defects.To improve the therapeutic efficacy,it is necessary for a surgeon to master the principles for treating open fractures.