摘要
目的探讨伴血管损伤的下肢严重开放性骨折的手术方法。方法回顾性分析我科2009年2月～2010年2月收治的伴血管损伤的下肢严重开放性骨折97例,其中股骨远端骨折及股骨髁部骨折38例,胫骨平台骨折59例;股动脉损伤53例,腘动脉损伤44例。患者受伤至入院时间1～23h,平均(3.6±1.2)h。患者均Ⅰ期应用外固定支架治疗,按照Ⅱ期内固定更换与否,分为两组,即A组,Ⅱ期更换为内固定,56例;B组未更换内固定,41例。术后随访评价骨折愈合时间、并发症发生率以及关节功能恢复情况。按Evanich膝关节评分系统(改良HSS)标准评定,分为优、良、中、差四级。结果平均随访(12.5±3.5)个月,两组患者骨折愈合时间无显著性差异(P>0.05)。A组患者并发症发生率(5.4%)明显低于B组(29.3%)(P<0.05)。关节功能评分中,A组优良率为91.1%,B组优良率为82.9%,二者有统计学差异(P<0.05)。结论伴血管损伤的下肢开放性骨折,可Ⅱ期更换为内固定治疗,关节功能恢复较好,且并发症发生率较低,值得临床推广应用。
Objective To discuss the fixation methods for treating lower limb fractures associated with vascular injuries. Methods Ninety-seven patients with lower limb fractures combined with vascular injuries were ret- rospectively studied from Feb. 2009 to Feb. 2010, including 38 cases of distal femoral or femoral condyle fractures, 59 cases of tibial plateau fractures. Femoral artery injury was observed in 53 cases and popliteal artery injury in 44 cases. The time from injury to operation was 1 hour to 23 hours, and the average time was （ 3.6 ±1.2 ） hours. All the cases were divided into 2 groups according to whether internal fixation was changed in the second stage. Group A included 56 cases with changing internal fixation in the second stage. Group B included 41 cases without changing internal fixation. The fracture healing time, complication rates and recovery of joint function were evaluated. Functional outcomes were graded into excellent, good, fair and poor based on Evanich knee scoring system （modified HSS）. Results All the patients were followedup for 12.5 ± 3.5 months. There was no significant difference between group A and group B in the fracture healing time （ P 〉 0.05 ）. The complications rates in group A （ 5.4% ） were significantly lower than those of group B （29.3%） （ P 〈 O. 05 ）. The excellent and good rate of the joints function in group A was 91.1% （ 51/56 ） , 82.9% in group B （ 54/41） , showing a statistical significant difference （ P 〈 O. 05 ）. Conclusion For patients with open fractures of lower limb combined with vascular injury,changing internal fixation in the second stage is highly beneficial for the joint function and has a lower incidence of complications which deserves further clinical applications.
出处
《创伤外科杂志》
2012年第6期520-522,共3页
Journal of Traumatic Surgery
关键词
下肢骨折
血管损伤
固定术
lower limb fractures
vascular injury
fixation
