单边可延长外固定支架治疗GustiloⅢ B/C型胫骨开放性骨折伴骨缺损

Effect of unilateral producible external fixation apparatus on treating open tibia fracture(Gustilo Ⅲ B/C) with bone defect

目的 探讨应用单边可延长外固定支架治疗GustiloⅢB、C型开放性胫骨骨折并骨缺损的临床疗效。方法 2011年6月至2014年6月,应用单边可延长外固定支架治疗GustiloⅢB/C型开放性胫骨骨折并骨缺损21例。主要方法 ：一期清创清除游离碎骨及严重污染的骨组织,修整骨折端整齐后短缩患肢对合、修复血管神经肌腱,安装单边可延长外固定支架,并在胫骨近端截骨;术后2周开始骨搬运延长,逐渐延长恢复短缩部分胫骨,恢复肢体长度,骨折愈合后拆除外固定支架。结果 本组21例随访时间10个月-3年,平均18个月。17例均通过一期短缩肢体修复创面,3例通过局部旋转皮瓣修复创面,1例局部皮瓣部分坏死后通过植皮修复创面。所有骨折端及截骨端最终全部愈合,骨折愈合时间为5-13个月,平均时间8个月。结论 应用单边可延长外固定支架治疗GustiloⅢB/C型开放性胫骨骨折伴骨缺损,通过急诊短缩患肢消灭创面,同时胫骨干骺端截骨延长的治疗方案,最终肢体长度恢复、骨折愈合。

Objective To investigate the clinical efficacy of unilateral producible external fixation apparatus for treatment of open tibia fracture with bone defect. Methods Twenty-one cases with fresh open tibia fracture（GustiloⅢB / C） with bone defect between June 2011 and June 2014 were included in this study and analyzed retrospectively. The surgical procedure was performed as follow ： after onestage debridement,.esquillectomy or elimination of heavily polluted bone tissue and repairing damaged blood vessel and nerve,.the unilateral producible external fixation apparatus was used to perform external tibia fixation. Then, operation of the superior extremity tibia osteotomy for bone-extension was done and bone transport operation began 2 weeks after operation..The external fixation apparatus was removed when bone got union. Results The average follow-up period was 18 months（range, 10 months to 3 years）. Complete heal was achieved in 17 patients by one-stage operation. Three cases underwent local rotation flap and one case received thickness skin graft due to necrosis of skin flap..Complete union was achieved in all 21 cases. No refracture was observed after the removal of the external fixator,and the average healing time was 8 months.（range,.5 to 13）. Conclusion Unilateral producible external fixation apparatus is an effective surgical approach for treating open tibia fractures by the way of esquillectomy, tibia osteotomy, bone transport for bone-extension.