摘要
目的探讨胫腓骨中下段开放性骨折的手术方式并分析其临床疗效.方法自1998年4月～2004年7月共手术治疗胫腓骨中下段开放性骨折146例149肢.Gustilo分类:Ⅰ型28例,Ⅱ型58例,Ⅲ型60例.其中使用交锁髓内钉治疗44例47肢(A组),使用钢板内固定治疗46例(B组),使用胫骨外固定架及腓骨1/3管型钢板治疗56例(C组).平均随访27个月后分析各组骨折愈合时间及术后并发症并进行比较.结果平均骨折愈合时间,A组5.1个月,B组5.6个月,C组7.9个月.术后并发症:A组:感染2例,无断钉,无畸形愈合.B组:感染及皮肤坏死¨例,钢板断裂3例,畸形愈合2例.C组:感染1例,外固定架钉道感染松动3例,畸形愈合2例.结论Ⅰ型、Ⅱ型均可使用交锁髓内钉治疗以使骨折达到一期愈合;所有胫腓骨中下段开放性骨折最好少用或不用胫骨解剖型钢板或窄加压钢板;外固定架及腓骨1/3管型钢板是治疗Ⅲ型损伤安全、简单的方法,可以考虑首选治疗措施.
Objective To investigate surgical treatment methods of open fracture in the middle and distal part of tibial fibula shaft and analyze the clinical therapeutic effect. Methods From April 1998 to July 2004, 149 tibia fibula from 146 patients with open fracture in middle and distal part were treated operatively and followed up for an average of 27 months. According to gustilo classification system, there were 28 type Ⅰ , 58 type Ⅱ and 60 type Ⅲ. Forty- seven fractures from 44 patients were treated by intramedullary nails （group A）. Forty-six were fixed by plate （group B） and 56 were by external fixtor （group C）. They were evaluated with the average healing time and postoperative complications. Results The average fracture healing time was 5.1 months in group A, 5.6 months in group B, and 7.9 months in group C. There occurred 2 infection in group A, 11 in group B and 1 in group C. Plate breakage happened in 3 eases of group B. Two cases of deformity union were found in group B and 2 in group C. Conclusion The type Ⅰ and type Ⅱ open fracture in middle and distal part of tibial shaft should be fixed by intramedullary nailing. The type Ⅲ fracture can be treated safe and simple by tibia external fixator and fibula 1/3 tubular plate.
出处
《中国骨与关节损伤杂志》
2005年第8期534-536,共3页
Chinese Journal of Bone and Joint Injury
