单侧外固定支架治疗不同部位胫腓骨严重开放性骨折  

Treatment of Severe Open Fracture of Tibia and Fibula with Unilateral External Fixator and Its Influence on Joint Function

作　　者：刘文和 [1] 李杰锋 [2] 熊波 [2] 陈志伟 [1] 王斌 [1] 李先安 [1] 李康华 [1] 

机构地区：[1]中南大学湘雅医院骨科,长沙市,410008 [2]湖南省郴州市第一人民医院

出　　处：《中国骨与关节损伤杂志》2005年第3期163-165,共3页Chinese Journal of Bone and Joint Injury

摘　　要：目的评价单侧外固定支架治疗胫腓骨不同部位严重开放性骨折的疗效及对关节功能的影响。方法对120例胫腓骨不同部位严重开放性骨折予以单侧外固定支架治疗,根据是否跨关节固定而分为三组。A组18例骨折位于胫腓骨上段,支架治疗需要跨膝关节固定。B组74例骨折位于胫腓骨中段,支架治疗不需要跨关节固定。C组28例骨折位于胫腓骨远端,可涉及关节面,支架治疗需要跨踝关节固定。疗效及关节功能结果评定分为优、良、可、差四级。结果A组骨折愈合的优良率61.1%(11/18),其关节功能优良率88.9%(16/18);B组骨折愈合的优良率91.9%(68/74),其关节功能优良率95.9%(71/74);C组骨折愈合的优良率71.4%(20/28),其关节功能优良率89.3%(25/28)。各组之间的骨折愈合与关节功能恢复的优良率的比较,B组与A组和C组之间的差异有统计学意义(P<0.05);A组与C组之间的差异没有统计学意义(P>0.05)。结论单侧外固定支架对伴有软组织缺损的严重开放性胫腓骨骨折的治疗具有独特的优势,跨关节固定时,对关节功能有一定程度的影响。Objective To evaluate the clinical effect of unilateral external fixator on the treatment of severe open fractures in different zones of tibia and fibula and its influence on joint function.Methods From 1996 to 2003,120 cases of severe open fractures in different zones of tibia and fibula were divided into 3 groups and treated as follows.Eighteen cases in group A were near knee joint and fixed across the joint.Seventy four cases in group B were in middle zone of tibia and fibula and fixed across neither knee joint nor ankle joint.Twenty eight cases in group C were near ankle joints and articular surface and fixed across ankle joint.The treatment outcome was graded as excellent,good,fair and poor.Results The excellent and good rate of fracture healing was 61.1%(11/18),91.9% (68/74) and 71.4%(20/28)in group A,group B and group C respectively.The excellent and good rate of joints function was 88.9%(16/18),95.9%(71/74) and 89.3%(25/28) respectively.Group B was the best compared with group A and group C (P<0.05).No significant difference was observed between group A and group C.Conclusion Unilateral external fixator is especially good at the treatment of severe open fractures of tibia and fibula combined with severe injury of soft tissue.It slightly affects the articular function when fixation across the joint.

关 键 词：外固定支架治疗 胫腓骨严重开放性骨折 不同部位 严重开放性胫腓骨骨折 单侧外固定支架 跨关节固定 骨折愈合 跨踝关节固定 关节功能恢复 优良率 胫腓骨远端 软组织缺损 腓骨上段 结果评定 统计学 C组 B组 关节面 疗效 

分 类 号：R683.42[医药卫生—骨科学] R282.71[医药卫生—外科学]