外固定架结合负压封闭引流治疗Gustilo ⅢB型胫腓骨骨折的疗效分析

目的：分析外固定架结合负压封闭引流（VSD）治疗GustiloⅢB型胫腓骨开放性骨折的临床疗效。方法：选择2009年1月—2012年12月收治的GustiloⅢB型胫腓骨开放性骨折患者34例，分为两组。研究组18例，使用外固定架结合负压封闭引流治疗，均急诊给予彻底清创，复位骨折端，外固定架固定后行负压封闭引流，7～10d后拆除VSD，视情况给予更换VSD或植皮、皮瓣转移修复皮肤缺损及骨外露区。对照组16例，给予急诊清创外固定架固定术治疗，术后给予常规换药，视情况行植皮或皮瓣转移修复皮肤缺损及骨外露区。结果：研究组随访6～12个月，17例创面愈合，愈合时间为（19．3±5．2）d，1例发生骨髓炎。对照组随访7～13个月，13例创面愈合，愈合时间为（35．8±6．9）d，3例发生骨髓炎。结论：外固定架结合负压封闭引流治疗GustiloⅢB型胫腓骨开放性骨折操作简单，可有效处理软组织缺损，明显缩短创面修复时间，减少并发症，提高治疗效果。

GustiloⅢA型胫骨开放性骨折采用Ⅰ期内固定方式治疗的效果观察

目的 探讨GustiloⅢA型胫骨开放性骨折患者应用Ⅰ期内固定方式和外固定支架两种方式治疗的效果差异。方法 选取2014年1月~2016年3月我院骨科接受诊治的82例GustiloⅢA型胫骨开放性骨折患者,随机分为观察组（41例）和对照组（41例）,给予观察组患者Ⅰ期内固定方式治疗,给予对照组患者外固定支架治疗,比较两组患者的骨折愈合效果。结果 观察组患肢功能恢复情况优于对照组,差异有统计学意义（P〈0.05）;观察组患者骨折愈合率为97.56%,明显高于对照组的73.17%,差异有统计学意义（P〈0.01）;观察组患者伤口及外固定架钉道感染率为4.88%,明显低于对照组的24.39%,差异有统计学意义（P〈0.01）。结论 GustiloⅢA型胫骨开放性骨折患者在应用Ⅰ期内固定方式治疗后可明显提高患肢功能恢复程度及骨折愈合率,利于骨折的恢复。

负压引流技术治疗GustiloⅢ型胫骨开放骨折的临床观察

目的比较负压引流技术(vacuum sealing drainage,VSD)和传统换药方法治疗GustiloⅢ型胫骨开放骨折的临床效果.方法将78例GustiloⅢ型胫骨开放骨折患者分为观察组和对照组,观察组43例,采用负压引流技术治疗,对照组35例,采用传统换药方法治疗;比较2组患者手术及恢复情况、临床疗效以及不良反应发生率.结果 2组患者住院时间、创面恢复时间以及骨折愈合时间比较,观察组均显著小于对照组,差异具有显著性(P<0.05);观察组治疗优良率为83.72%,显著高于对照组65.71%,差异有统计学意义(P<0.01).2组不良反应发生率比较,观察组为6.98%显著低于对照组17.14%(P<0.05).结论负压引流技术治疗GustiloⅢ型胫骨开放骨折能够大大缩短患者创面恢复时间和骨折愈合时间、降低感染等不良反应发生率,疗效显著,值得临床推广应用.

Single stage management of Gustilo type Ⅲ A/B tibia fractures： Fixed with nail ＆ covered with fasciocutaneous flap

Purpose： To evaluate the role of immediate and definitive management of Gustilo type Ⅲ A/B tibia fractures with intramedullary nailing and fasciocutaneous flap. Methods： From August 2010 to July 2012, 22 patients with Gustilo Grade Ⅲ A/B tibia fractures were managed with a single stage treatment of ipsilateral fasciocutaneous flap ＆ reamed intramedullary nailing and were included in the study. The severity of the injury was calculated with Ganga Hospital injury severity score. Results： The mean age of patients was 41 years and the follow-up time ranged from six months to one year. Among the 22 patients, 73% were type Ⅲ B fractures with upper leg involved in 55% of them. The time interval from injury to completion of surgery was 8 14 h. The incidence of bone infection requiring secondary procedure was 9%; the major and minor soft tissue complication rate was 9% and 14% respectively. The limb salvage rate was 100%. Conclusion： Multidisciplinary management of severe lower limb trauma is important and provides good outcomes, lntramedullary nailing and immediate flap fixation can achieve early bone union and good soft tissue coverage, leading to good outcomes in patient with Grade Ⅲ A ＆ B tibia fractures.