锁定钢板联合VSD治疗GustiloⅢA胫骨骨折的临床治疗观察

Clinical observation of locking compression plate combined with vacuum sealing drainage in treatment of tibia fracture of GustiloⅢA

目的比较封闭式负压引流(VSD)情况下,钢板内固定与外固定架治疗GustiloⅢA胫骨骨折的临床疗效。方法回顾性分析2011年10月—2016年6月收治且符合选择标准的32例GustiloⅢA开放性胫骨骨折的临床资料,其中12例采用锁定加压接骨板,20例采用外固定架固定,均使用负压引流治疗。两组患者性别、年龄、致伤原因、骨折分型、NISSA质量评分比较,差异均无统计学意义(P>0.05)。对两组患者术后感染、骨折畸形愈合、功能恢复优良率进行比较分析。结果术后随访8~18个月(平均13个月),两组的术后感染率、畸形愈合率、功能优良率分别为A组:16.67%、8.33%、75%,B组25%、10%、60%;两组骨折畸形愈合及功能优良率方面有统计学意义(P<0.05),在术后感染率上并无统计学意义(P>0.05)。结论钢板内固定联合VSD治疗GustiloⅢA开放性胫骨骨折,相对于外固定架固定,能降低骨折畸形率,改善患肢功能,且不一定增加感染发生率,是一种可行的治疗方法。

Objective The study was designed to review the outcomes of locking plate combined with vacuum sealing drainage（ VSD） and external fixator in the treatment of Gustilo III A tibial fractures. Methods Retrospective analysis of October 2011 to June 2016 treated and meet the selection criteria of 32 cases of Gustilo Ⅲ A open tibial fractures clinical data,12 cases were treated with compression compression plate,20 cases were fixed with external fixation,and negative pressure drainage was used. There were no significant differences in sex,age,causes of injury,fracture type and NISSA quality score between the two groups,then the postoperative infection,rate of malunion and functional recovery rate were compared between the two groups. Results The patients were followed up for 8 to 18 months（ mean,13 months）. Two groups of postoperative infection rate,the rate of malunion,the rate of functional recovery in group A：16. 67%,8. 33%,75%; group B： 25%,10%,60%. There was significant difference between the two groups in the rate of malunion and the rate of functional recovery（ P〈 0. 05）,but there was no difference in postoperative infection rate（ P 〉0. 05）. Conclusion Compared with external fixator for the Gustilo Ⅲ A open tibia fractures,the method of LCP combined with VSD can lower the rate of malunion,Improve limb function,is a reliable treatment.