摘要
目的探讨胫骨开放性骨折的治疗原则. 方法对1995年1月-2001年12月收治的152例胫骨开放性骨折患者进行回顾分析.按Gustilo法进行分型,其中Ⅰ型56例,Ⅱ型37例,ⅢA型33例,ⅢB型17例,ⅢC型9例.随访20～65个月,平均40个月. 结果 56例Ⅰ型损伤3～4个月骨折愈合,无感染.33例Ⅱ型损伤3～5个月骨折愈合,4例(11%)需Ⅱ期植骨,4例(11%)感染.26例ⅢA型损伤4～6个月骨折愈合,7例(21%)需Ⅱ期植骨,8例(24%)感染.11例ⅢB型损伤4～8个月骨折愈合,6例(35%)需Ⅱ期植骨(3例多次植骨),8例(47%)感染.ⅢC型损伤中截肢5例(3例Ⅰ期截肢);2例延期截肢;4例经多次植骨,6～8个月骨折愈合;6例(67%)感染. 结论胫骨开放性骨折应视为急诊手术,尽早使用抗生素,充分冲洗,彻底清创,稳定骨折,延迟闭合伤口,早期进行自体骨移植.
Objective To explore the treatment principles for open fractures of the tibia. Methods A retrospective survey was performed in 152 patients with open fractures of the tibia that were operatively treated between January 1995 to December 2001 and followed up for 20-65 months (average 40 months). According to the Gustilo classification, there were 56 cases of type Ⅰ fractures, 37 type Ⅱ fractures, 33 type ⅢA fractures, 17 type ⅢB fractures and nine type ⅢC fractures. Results Type Ⅰ fractures were healed 3-4 months after fracture, with no infections. Of 33 cases of type Ⅱ fractures that were healed 3-5 months after injury, four (11%) needed secondary bone implantation and four(11%) had infection. Of 26 cases of type ⅢA fractures, seven (21%) resulted in delayed union and eight (24%) got infections. Of 11 cases of type ⅢB fractures, six (35%) gave rise to delayed union and eight (47%) infections. Among type ⅢC fractures were five with amputation (three with one stage amputation and two with secondary amputation), of which four got bone union 6-8 months after again bone graft but six (67%) was infected. Conclusions The open fracture of the tibia must be treated with various methods including early use of antibiotics, copious rinse of the wound, complete debridement, stabilization of the fracture, delayed wound closure and early cancellous bone graft.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2005年第2期91-93,共3页
Chinese Journal of Trauma
关键词
胫骨开放性骨折
治疗
外固定器
抗生素
Tibial fractures
Fracture, open
Fracture fixation, internal
Bone screw
External fixators
