应用胫骨Ⅰ期短缩加Ⅱ期延长治疗严重胫骨开放性骨折  

Primary shortening plus secondary lengthening of the tibia for sever tibial fractures

作　　者：彭阿钦[1] 吴春生[1] 宋连新[1] 张世强[1] 宋朝辉[1] 张英泽[1] 

机构地区：[1]河北医科大学第三医院创伤急救中心,石家庄050051

出　　处：《中华创伤骨科杂志》2011年第6期508-512,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的评价应用胫骨Ⅰ期短缩加Ⅱ期延长的方法治疗严重胫骨开放性骨折的临床效果。方法自2006年5月至2009年8月应用胫骨Ⅰ期短缩加Ⅱ期延长治疗5例严重胫骨开放骨折患者，均为男性；年龄23～41岁，平均35岁。清创和胫骨短缩后用单边外固定支架临时固定，血管损伤者行动脉吻合。1例伤口Ⅰ期闭合，2例经植皮后愈合，2例分别通过腓肠神经营养支筋膜瓣和交腿皮瓣闭合伤口。伤口愈合后从胫骨近端做截骨，应用Ilizarov架行胫骨延长，恢复小腿的长度。胫骨短缩3～5cm，平均4．2cm。结果所有患者术后获18—24个月（平均20个月）随访。患者骨折短缩处伤口均获愈合，无一例发生感染。全部患者骨折均获愈合，愈合时间为6—12．5个月，平均9．6个月，平均愈合指数1．7个月／cm，患肢长度均恢复，与健侧无差别。按Paley功能评价标准：优3例，良1例，可1例。结论应用胫骨Ⅰ期短缩加Ⅱ期延长治疗严重胫骨开放性骨折，具有安全可靠、简化治疗过程及减少皮瓣应用等优点，是一种较好的方法。Objective To evaluate clinical results of primary shortening plus secondary lengthening of the tibia for sever tibial fractures. Methods From May 2006 to August 2009, 5 men with severe open tibial fracture were treated with primary shortening plus secondary lengthening of the tibia in our center. They were aged from 23 to 41 years （average, 35 years） . Four cases were Gustilo type ⅢB and one was Gustilo type ⅢC. The primary procedure included debridement, shortening of the tibia and temporary fixation with a unilateral external fixator, and arterial anastomosis in cases of vessel injury. The wounds healed primarily in one case, after skin graft in 2 cases, and after flap transplantation in 2 cases. After wound healing, secondary lengthening of the tibia was performed following osteotomy of the proximal tibia with an Ilizarov fixator to re- store the length of the injured leg. The average shortening was 4.2 cm （range, 3 to 5 cm）. Results The average follow-up period was 20 months （range, 18 to 24 months）. All the wounds were healed without signs of osteomyelitis. All the fractures united. The mean bone healing time was 9.6 months （range, 6 to 12. 5 months） . The average healing index was 1.7 months/cm. A normal length was restored in all the affected lower limbs. By Paley functional assessment system, 3 cases were excellent, one was good and one was fair. Conclusion Primary shortening plus secondary lengthening of the tibia is a reliable and successful method for sever tibial fractures, because it can simplify management and minimize the need for flap coverage.

关 键 词：胫骨 骨折 骨缺损 短缩 

分 类 号：R687.3[医药卫生—骨科学]