可调节组合式外固定器治疗胫腓骨干开放性骨折的效果观察

Effect of adjustable combined external fixator in treating open tibiofibular shaft fractures

目的观察可调节组合式外固定器治疗胫腓骨干开放性骨折的临床效果。方法回顾性分析38例GustiloⅠ、Ⅱ型开放性胫腓骨干骨折患者的临床资料,患者均采用可调节组合式外固定器治疗,早期清创安装外固定器于胫骨上,当X线片显示有少量骨痂形成后调整简化构型,直至达到临床愈合标准,当X线片显示骨痂通过骨折线,骨折线已消失或接近消失时去除外固定器。结果本组38例患者平均年龄为(43.89±10.99)岁,平均随访(47.84±9.20)周,除1例患者在随访过程中出现骨髓炎外,其余患者骨折断端均达到骨性愈合标准。本组患者外固定器平均固定时间为(17.53±2.95)周,平均带架时间为(21.53±2.63)周。末次随访时采用Johner-Wruhs功能评分标准评估疗效,优23例,良8例,可6例,差1例,优良率为81.58%。2例患者发生钉道周围轻度感染,经反复清创换药并联合应用抗生素后痊愈;1例患者拆除外固定器后再次骨折,给予石膏外固定联合后期护具固定后骨折愈合良好;1例患者出现伤口感染并演变为骨髓炎,给予清创及截骨延长手术治疗,预后良好。结论可调节组合式外固定器治疗作为胫骨干开放性骨折的终极治疗方式,可减少骨折端血运破坏,降低感染发生率及二次手术概率,缩短外固定器固定时间及骨折断端愈合时间。

Objective To observe the clinical efficacy of an adjustable combined external fixator in treating open tibiofibular shaft fractures.Methods The data of 38 open tibiofibular shaft fractures patients with grading GustiloⅠandⅡwas retrospectively analyzed,and all the patients were treated with adjustable combined external fixators.The wounds got debrided and the external fixator got installed on the tibia.The fixator would be simplified when a small amount of porosis was observed by X ray.Clinical healing standard was achieved when X ray findings showed that the callus passed through the fracture and the line of fracture had disappeared or almost disappeared,and fixator got removed.Results The average age of 38 patients was(43.89±10.99)years,and the mean follow-up period was(47.84±9.20)weeks.Fracture broken ends of all cases achieved bone union except one of them occurred osteomyelitis.The average fixation time was(17.53±2.95)weeks,and average time of wearing external fixator was(21.53±2.63)weeks.The clinical evaluation of the latest follow-up was performed by Johner-Wruhs score,which included excellent efficacy in 23 cases,good efficacy in 8 cases,fair efficacy in 6 cases and bad efficacy in 1 case,with excellent rate of 81.58%.Two cases got slight infection around the nail paths,and were cured after debridement and antibiotics treatment.One case got refracture after the fixator removed and healed well after plaster external fixation combined with protective devices in latter healing period.One case occurred wound infection and developed into osteomyelitis finally,and had better prognosis after debridement and osteotomy.Conclusion The adjustable combined external fixator as a ultimate treatment for open tibiofibular shaft fractures can reduce the blood supply damage of the fracture end,decrease the incidence of infection and the probability of second operation,and shorten the fixation time of the external fixator and the healing time of the fracture end.