桥接组合式内固定系统外固定治疗开放性胫骨中下段骨折

Treatment of open middle and lower tibial fractures with bridge-link combined fixation system external by means of external fixation

目的:探讨采用桥接组合式内固定系统(bridge-link combined fixation system,BCFS)外固定治疗开放性胫骨中下段骨折的临床疗效。方法:自2016年10月至2017年9月,采用BCFS外固定治疗11例开放性胫骨骨折患者,其中男7例,女4例;年龄23~65岁,平均44.2岁;病程7~10 d。所有骨折为开放性胫腓骨中下段骨折。骨折按AO分型:A型5例,B型5例,C型1例;按Gustilo-Anderson分型均为Ⅱ型。观察患者的骨折愈合时间及术后并发症情况,并采用Johner-Wruhs标准对临床疗效进行评价。结果:11例患者均获得随访,时间7~13个月,平均10.1个月;骨折愈合时间4~8个月,平均6.2个月;BCFS拆除时间5~11个月,平均7.8个月。术后均无螺钉松动及桥接系统断裂等情况发生,其中1例患者术后出现胫骨前侧近端及远端钉道相继感染,经抗炎及换药处理后治愈。根据Johner-Wruhs评价标准,本组优8例,良3例。结论:桥接组合式内固定系统可经外固定方式治疗开放性胫骨中下段骨折,其体积小、使用灵活、立体固定、弹性固定,不仅能有效降低组织损伤,促进骨折愈合,且具有术后并发症少、患肢功能恢复好的优点。

Objective:To explore clinical effect of bridge-link combined fixation system(BCFS)in treating open middle and lower tibial fractures by external fixation.Methods:From October 2016 to September 2017,11 patients with open middle and lower tibial fractures were treated with BCFS by external fixation,including 7 males and 4 females aged from 23 to 65 years old with an average of 44.2 years old;the course of disease ranged from 7 to 10 days.All fractures were open,middle and lower tibiofibular fractures.According to AO classification,5 patients were type A,5 patients were type B,and 1 patient was type C.All fractures were classified as typeⅡaccording to Gustilo-Anderson classification.The time of fracture healing,postoperative complications were observed,Johner-Wruhs standard were used to evaluate clinical effect.Results:All patients were followed up from 7 to 13 months with an average of 10.1 months.Fracture healing time ranged from 4 to 8 months with an average of 6.2 months.The removal time of BCFS ranged from 5 to 11 months with an average of 7.8 months.No screws loosening and BCFS breakage occurred after operation,while 1 patient occurred infection of proximal and distal tibia after operation which was healed by anti-inflammatory treatment and dressing change.According to Johner-Wruhs standard,8 patients were excellent and 3 patients good at the latest follow-up.Conclusion:BCFS could be used to treat open middle and lower tibial fractures by external fixation,which had features of small size,flexible use,solid and elastic fixation.It could not effectively reduce tissue injury and promote fracture healing,but also have advantages of less postoperative complications and better recovery of limb function.