组合式外固定架治疗重度胫骨近端骨折的初步报告  

Preliminary report of composite external fixator in the treatment of the severely proximal tibial fractures

作　　者：张伯锋[1] 李衡[1] 张立兴[1] 彭阿钦[1] 齐向北[1] 王志红[1] 李志[1] 侯志勇[1] 李增力 

机构地区：[1]河北医科大学第三医院骨科创伤急救中心,石家庄050051 [2]河北衡水康达医疗器械公司

出　　处：《中华骨科杂志》2005年第1期21-24,共4页Chinese Journal of Orthopaedics

基　　金：河北省科委资助课题(012761240D)

摘　　要：目的探讨应用自行设计的组合式外固定架治疗严重粉碎性或开放性胫骨近端骨折的方法与疗效。方法自2000年7月至2003年1月采用组合式外固定架治疗严重粉碎性或开放性胫骨近端骨折22例,男15例,女7例;年龄20～80岁,平均43岁。胫骨近端骨折按Schatzker分型标准,Ⅳ型8例,Ⅵ型14例。治疗采用闭合间接复位,必要时结合有限切开空心螺钉或克氏针内固定。结果全部病例均获得随访,随访时间6～21个月,平均11个月。外固定架使用时间平均为4.5个月,骨折愈合时间平均为5个月。4例行自体髂骨植骨。20例骨折一期愈合,2例骨折延期愈合者经二期植骨后愈合。6例开放性骨折者无一例发生感染;其余16例闭合性骨折者无伤口感染、皮肤坏死,仅4例发生针道局部感染,经换药后治愈。19例术后膝关节活动度≥90°(包括3例Ⅱ期行膝关节松解术患者),2例膝关节活动度为60°,1例为45°。1例发生创伤性关节炎,需间断服用非甾体类抗炎药。按照Merchant评分标准对术后功能进行综合评分,优14例,良3例,可3例,差2例,优良率为77.3%。结论应用组合式外固定架治疗严重粉碎性或开放性胫骨近端骨折,手术创伤小,固定可靠,膝关节可早期活动,治愈率高,并发症少,疗效满意。Objective To explore the clinical outcome of self-designed composite external fixator in the treatment of severely comminuted or open proximal tibial fractures. Methods From July 2000 to January 2003, 22 cases of severely comminuted or open proximal tibial fractures were treated by self-designed composite external fixators, which involved 15 males and 7 females with an average age of 43 years (range, 20-80 years). This technique consisted of indirect reduction and limited open cannulated screw or K-wires fixation in case of necessity. Results All the patients had achieved fracture union at the 5th month averagely after operation. The period of follow-up was from 6-21 months(mean, 11 months). The mean duration of external fixation was 4.5 months. 4 cases received bone autograft from the iliac crest, primary union occurred in 20 cases, 2 cases with delayed union healed after bone-grafting. No infection occurred in 6 cases with open fracture. The other 16 cases also had no infection or skin necrosis. Only 4 cases with pin track infection healed by dressing change. 19 cases had knee flexion beyond 90°(containing 3 cases with second-stage knee release), 2 was 60° and 1 was 45°. 1 case took NSAIDs intermittently because of traumatic arthritis. According to Merchant grade, 14 were evaluated as excellent, 3 as good, 3 as fair and 2 as poor. The rate of excellent and good results was 77.3%. Conclusion The composite external fixator in treating the severely comminuted or open proximal tibial fracture has the following advantages, such as less-invasion, stable fixation, early-mobilization, high union rate and fewer complication.

关 键 词：治疗 胫骨近端骨折 组合式外固定架 粉碎性 膝关节 活动度 并发症 发生 使用时间 综合评分 

分 类 号：R687[医药卫生—骨科学]