胫腓骨开放性骨折中西医结合治疗56例

Therapy of Integrated Traditional Chinese and Western Medicine in the Treatment of Open Fractures of the Tibia and Fibula for 56 Cases

目的探讨胫腓骨开放性骨折的治疗方法。方法回顾分析作者2008年1月-2018年2月收治的56例胫腓骨开放性骨折的治疗方法进行分析。对于开放性骨折,早期进行彻底的清创,根据开放的程度和骨折的程度,选择合适的固定方式,采用多元化的治疗,积极的预防感染,重点加强对软组织的处理。根据骨折和软组织情况Ⅱ期选择合适的内固定或者选择外固定。所有患者在此基础上接结合中医药治疗,即围手术期给予中医辨证治疗,术后按中西医结合的治疗(chinese osteosynthesis,CO)理念指导功能锻炼。结果在随访到的52例患者中,骨折顺利愈合43例,因血管栓塞坏死而截肢的1例,骨髓炎的2例,骨折延期愈合3例,内固定断裂而重新手术更换内固定的1例,骨折不愈合手术更换内固定并植骨的2例。结论胫腓骨开放性骨折,尤其是AO分型的C3.3型、GustiloⅢC型骨折,临床治疗难度大,并发症多,愈合往往较差。早期彻底的清创,积极的预防感染,急诊时对软组织的保护和正确的处理非常重要,后期的治疗应根据分型和软组织的情况以及结合中医药治疗进行多元化的处理和选择。

Objective To explore the treatment of open fractures of the tibia.Methods A retrospective analysis of 56 patients with open fractures of the tibia from January 2008 to February 2018 was performed.For open fractures,early thorough debridement,according to the degree of openness and the degree of fracture,choose the appropriate fixation method,use a variety of treatments,actively prevent infection,and focus on the treatment of soft tissue.According to the stage of fracture and soft tissue,choose appropriate internal fixation or choose external fixation.All patients were treated with traditional Chinese medicine on the basis of this,that is,the perioperative period was given TCM syndrome differentiation treatment,and the postoperative operation was guided by the concept of Chinese and Western medicine combined with osteosynthesis(CO).Results Among the 52 patients who were followed up,43 cases were successfully healed,1 case was amputated due to vascular thrombosis,2 cases were osteomyelitis,3 cases were delayed healed,1 case was fixed with internal fixation and 1 case was re-operated and replaced.2 cases of internal fixation and bone graft were replaced by nonunion surgery.Conclusion Open fractures of the humerus,especially the C3.3 and Gustilo IIIC fractures of AO classification,are difficult to treat clinically,have many complications,and often have poor healing.Early thorough debridement,active infection prevention,protection of soft tissues and proper management during emergency treatment are very important.Late treatment should be treated and selected according to the classification and soft tissue conditions and combined with traditional Chinese medicine treatment.