摘要
目的 探讨对胫腓骨严重开放性粉碎性骨折的治疗方法的选择。 方法 胫腓骨GustiloⅢ型的严重损伤开放性粉碎性骨折 1 4 6例 ,其中ⅢA 92例 ,ⅢB 36例 ,ⅢC1 8例。男 1 0 8例 ,女38例 ,年龄 1 1～ 68岁 ,平均 31岁。采用单侧外固定支架 (UADF)与简单内固定 (普通螺钉或克氏针 )结合治疗。 30例经二期皮瓣转移消灭创面 ,其中腓肠肌带蒂皮瓣 1 9例 ,股外侧肌游离皮瓣 9例 ,背阔肌游离皮瓣 2例。 结果 本组ⅢB型 3例 ,因年龄大合并颅脑及胸腹部损伤而行截肢术 ,ⅢB型截肢率为 8%。ⅢC型 5例因术后血供障碍坏死而截肢 ,ⅢC型截肢率为 2 8%。余 1 38例骨折复位良好 ,固定稳定 ,创面消灭 ,均获随访。时间 6个月至 6年 ,平均 2 5年。骨折平均愈合时间 2 7周 ,取除内外固定时间平均 2 8周。膝关节活动范围 0°～ 1 2 0° 1 1 0例 ,0°～ 1 0 0° 2 5例 ,0°～ 90° 3例 ,踝关节活动范围基本正常。 结论 对胫腓骨严重开放性粉碎性骨折病例 ,应作病情的综合分析和判断 ,决定采用保肢或截肢。对年龄偏大或同时合并颅脑或胸腹部损伤患者 ,为抢救生命 ,倾向早期急诊截肢。应用单侧外固定支架与简单内固定 (普通螺钉或克氏针 )结合治疗胫腓骨严重开放性粉碎性骨折 ,操作简单 ,固定可靠 ,手术创伤小 ,符合微创术?
Objective To improve the treatment for severe open tibia fibular fracture. Methods From 1994 to 2000, 146 patients with severe open tibia fibular fracture were treated. According to Gustilo classfication, all patients were of type Ⅲ. Among them,96 patients belonged to ⅢA,36 ⅢB,and 18 ⅢC. One hundred and eight patients were male and 38 female, aged from 11 to 68 years, with an average of 31. All patients were treated with unilateral external fixator combined with simple internal fixation(general screw or Kirschner wire). Thirty patients were treated with secondary flap operation. Among them, 19 patients received pedicle gastrocnemius muscle fiaps, 9 free vastus lateralis muscle flaps, and 2 free latissimus dorsi muscle flaps. Results Three patients of type ⅢB were subjected to amputation because of advanced age and associated cerebral or thoraco abdominal injury. Five patients of type ⅢC had amputation because of insufficient postoperative blood supply and necrosis. The rupture of other 138 patients was well reducted, and firmly fixed. They were followed up for 6 months 6 years, with an average of 2 5 years. The average time of fracture union was 27 weeks, and the average time for removal of fixtors was 28 weeks. The motion of knee joint ranged from 0 to 120 degree in 110 patients; from 0 to 100 degrees in 25, and from 0 to 90 degrees. The motion of ankle joint was approximately normal. Conclusions For patients with severe open tibia fibular fracture, comprehensive analysis should be made for preservation of the wounded limb or ampulation as for elderly patients with vessel nerve injury or with cerebral thoracoabdominal injury, emergency ampulation should be done. Unilateral external fixator combined with simple internal fixation(general screw or Kirschner wire) for severe open tibia fibular fracture is advantage ous for a simple and reliable fixation. It is less traumatic.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2002年第11期855-857,W003,共4页
Chinese Journal of Surgery
