摘要
目的探讨Hybrid外固定支架治疗开放性胫骨干骺端骨折的疗效。方法2000年3月～2004年7月采用Hybrid外固定支架治疗开放性胫骨近端骨折19例,Pilon骨折6例。软组织损伤程度按Gustilo分类：Ⅱ型8例；ⅢA型10例,ⅢB型5例,ⅢC型2例。伤口彻底清创后直接缝合21例,4例通过皮瓣转移或游离皮瓣移植关闭,3例行深筋膜切开减压。11例骨折行闭合间接复位,14例通过延长伤口或有限切开复位,关节骨折尽可能解剖复位,并予有限内固定。所有患者骨折均用Hybrid外固定支架固定。结果所有患者获平均15．7个月(9～26个月)随访。外固定支架使用时间平均9．4个月(2．9～21．0个月)。骨折愈合时间平均8．8个月,其中2例二期改用钢板内固定加自体髂骨植骨后愈合。除2例创面延期愈合外,创口均一期愈合,未发生深部感染等严重并发症。19例胫骨近端骨折患者末次随访时膝关节活动超过90°者15例；未达70°者4例,但在膝关节松解术后活动超过90°。6例Pilon骨折患者踝关节活动范围均正常,其中2例术后11个月发生创伤性关节炎。按照Rasmussen临床与放射评分,本组中膝关节功能优13例,良3例,可2例,差1例,优良率为84．2%；踝关节功能优3例,良2例,差1例,优良率为83．3%。结论Hybrid外固定支架治疗开放性胫骨干骺端骨折能有效维持骨折稳定性,组织感染坏死率低,对关节活动影响小,但骨折愈合时间长,且有一定的不愈合率。
Objective To report the therapeutic results of Hybrid external fixator in treatment of open metaphyseal fractures of the tibia. Methods From March 2000 to July 2004, 19 cases of proximal tibial metaphyseal fractures and six cases of Pilon fractures were treated with Hybrid external fixators. By Gustilo classification, eight cases were of type Ⅱ, 10 type ⅢA, five type ⅢB and two type ⅢC. The wounds were closed directly after thorough debridement in 21 cases, and closed by pedicled flap transposition or free flap transplantation in four. Fasciotomy was performed in three. Closed indirect reduction of the fractures was done in 11 cases, while open reduction was carried out through an extended wound or a limited incision in 14. Anatomical reduction was done for the articular fractures, if any, and Hybrid external fixators were employed to stabilize fractures in all the cases in this series. Results All the patients had a mean follow-up of 15.7 months （ranging from 9 to 26 months） which revealed bone union of the fracture in all cases with a mean healing time of 8.8 months. Two patients had their external fixators replaced with plates and iliac bone graft to get fracture union. The fixators were removed 2.9 to 21 months （mean, 9.4 months） after operation. Except for two cases of secondary healing, all the wounds healed primarily without serious complication, such as infection. The final follow-up revealed a knee motion range of more than 90° in 15 cases, less than 70° in four, whose knee motion range was improved to more than 90° after knee release performed one year later. In all the six cases of Pilon fractures, the ankle joint recovered normal range of motion. Traumatic arthritis occurred in two cases of Pilon fracture 11 months after operation. Evaluation by Rasmussen＇s functional and radiological scoring system demonstrated excellent knee function in 13 cases, good in three, fair in two and poor in one, with a good to excellent rate of 84. 2%. The ankle function was excellent in three cases,
出处
《中华创伤骨科杂志》
CAS
CSCD
2006年第12期1128-1131,共4页
Chinese Journal of Orthopaedic Trauma
