多技术联合治疗GustiloⅢB型胫腓骨骨折疗效分析

Clinical Efficacy of Multi-technique Combination Therapy in Treating GustiloⅢB Type Tibiofibular Fracture

目的探讨多技术联合治疗GustiloⅢB型胫腓骨骨折的临床疗效。方法选取2018年6月至2021年8月四川大学华西第四医院收治的15例GustiloⅢB型胫腓骨骨折患者作为研究对象,所有患者均行外固定支架固定+负压封闭引流治疗。术后7~21 d,拆除负压封闭引流装置,软组织缺损创面行常规碘伏消毒换药治疗,后根据创面愈合情况改为“高渗”换药治疗、“高渗”与湿润烧伤膏交替换药治疗或植皮治疗,记录患者治疗情况、创面愈合时间、骨折愈合时间及患肢功能恢复情况。结果所有患者软组织缺损创面均完全愈合,愈合时间为25~95 d,平均45.8 d;骨折均完全愈合,愈合时间为24~36周;出院后随访6个月~1年,患肢功能恢复为优5例、良7例、可2例、差1例。结论外固定支架固定、负压封闭引流、“高渗”换药、湿润烧伤膏换药等多技术联合治疗GustiloⅢB型胫腓骨骨折,有利于促进软组织缺损创面及骨折愈合,改善患肢功能。

Objective To study the clinical efficacy of multi-technique combination therapy in treating GustiloⅢB type tibiofibular fracture.Methods Fifteen patients with GustiloⅢB type tibiofibular fracture,admitted to West China Fourth Hospital of Sichuan University from June 2018 to August 2021,were enrolled as research subjects,and all patients were treated with the external fixation brace fixation and vacuum sealing drainage.On days 7-21 after the operation,the vacuum sealing drainage device was removed,and the soft tissue defect wounds were treated with routine povidone iodine disinfection and dressing changes.Subsequently,based on the wound healing status,hypertonic dressing changes,alterna-ting hypertonic and MEBO dressing changes or skin grafting was performed.The patients’treatment outcomes,wound healing time,fracture healing time,and limb functional recovery were recorded.Results All patients’soft tissue defects healed completely,and the healing time was 25-95 d,with a mean healing time of 45.8 d.All fractures healed completely,and the healing time was 24-36 weeks.During the follow-up six months to one-year after hospital discharge,the functional recovery of the affected limbs of patients was evaluated as excellent in 5 cases,good in 7 cases,fair in 2 cases,and poor in 1 case.Conclusion The combined application of the external fixation brace fixation,vacuum sealing drainage,hypertonic dressing changes,and MEBO dressing changes in the treatment of GustiloⅢB type tibiofibular fracture can promote the healing of soft tissue defect and fracture,and improve the affected limb’s function.