外置锁定钢板一期治疗胫骨干开放性骨折

Locking Plate as a Definitive External Fixator for Treating Open Tibial Shaft Fractures

目的探讨外置锁定钢板一期治疗胫骨干开放性骨折的疗效。方法 2010年1月至2014年1月期间,共有14例胫骨干开放性骨折患者（GustiloⅠ型1例,GustiloⅡ型7例,GustiloⅢA型6例）,急诊行清创缝合后择期行锁定钢板外置手术。其中男10例,女4例;年龄22~76岁,平均50岁。末次随访时评估骨折愈合时间、畸形愈合、双下肢不等长、关节功能、深部感染以及钉道感染等情况。结果平均骨愈合时间37周（20~52周）。全部患者最终达骨性愈合,无畸形愈合,无钉道松动以及外固定失败;无深部感染发生,2例（14.3%）患者发生钉道感染。采用JohnerWruh评分标准进行疗效评价,优12例,良1例,中1例,优良率为92.9%。结论锁定钢板外置是治疗胫骨干开放性骨折的一种不错选择。

Objective To evaluate the outcome of using locking plate as a definitive external fixator for treating open tibial shaft fractures. Methods 14 consecutive open tibial shaft fractures（ one were Gustilo and Anderson type I,7 were type Ⅱand 6 were type ⅢA） were included in the present study from January 2010 to January 2014. All the patients were treated with urgent surgical débridement and irrigation; then they were electively treated using locking plate as a definitive external fixator.Time to union,nonunion,malunion,leg shortening,range of motion and function for the knee and ankle,deep infection,pin tract infections were evaluated. Results The mean bone healing time was 37 weeks（ range 20 ~ 52 weeks）. Eventually,all of the fractures united. Most of the fractures healed in acceptable positions. No loosening or failure of the external fixator was seen.There were no cases of deep infection. Pin tract infection was seen in 2（ 14. 3%） patient. According to the functional assessment by the Johner-Wruhs system,the excellent to good rate was 92. 9% at the most recent follow-up. Conclusion The locking plate used as a definitive external fixator may be a useful adjunct for treating open tibial shaft fractures.