复杂性胫腓骨骨折137例  

Treatment of 137 cases of complex tibial and fibular fractures

作　　者：刘仲前[1] 张耀明[1] 袁加斌[1] 吕波[1] 

机构地区：[1]四川省人民医院骨科,成都610071

出　　处：《中华创伤杂志》2000年第5期268-270,共3页Chinese Journal of Trauma

摘　　要：目的　探讨复杂性胫腓骨骨折治疗中骨折与软组织损伤处理的方法。　方法　对137例复杂性胫腓骨骨折的治疗进行分析。其中胫腓骨多段骨折 89例 ,伴有软组织缺损的胫腓骨开放粉碎骨折 2 7例 ,合并血管神经损伤的胫腓骨骨折 2 1例。有 118例获得 10个月～ 5年 2个月的随访 ,平均随访 2年 3个月。　结果　胫腓骨多段骨折治疗中 ,以Ender钉固定组发生骨折延迟愈合最少 ,Ⅰ期闭合伤口同时行减张切口减压组 ,皮肤发生坏死及感染机会最少。伴有软组织缺损的胫腓骨开放粉碎骨折治疗中 ,以外固定支架固定组发生骨折延迟愈合最少 ,软组织缺损修复以局部带蒂肌皮瓣及交腿肌皮瓣成活率最高。合并血管、神经损伤的胫腓骨骨折组无肢体坏死发生。全部 118例中 ,仅 7例有膝关节功能障碍。　结论　复杂性胫腓骨骨折软组织损伤的处理与骨折本身的处理有同等重要的意义 ,任何治疗措施的选择都要以能避免进一步加重软组织损伤为前提。骨折以Ender钉及外固定支架治疗为首选 ,软组织缺损以局部带蒂肌皮瓣及交腿肌皮瓣修复为主要方法 。Objective To find the optimal scheme on the basis of analysis of the treatment of complex tibial and fibular fractures. Methods We analyzed retrospectively 137 cases of complex tibial and fibular fractures. Among them, 89 cases had multi-segment fractures of the tibia and fibula, 27 complicated with soft tissue defect, and 21 complicated with vessel and nerve injury. Follow-up was conducted on 118 patients for 10 months to 5 years and 2 months with 2 years and 3 months on average. Results Ender's nail showed a minimum occurring rate of delay-union of the fractures in the treatments of multi-segment fractures of the tibia and fibula. Closing the wound in the first stage and performing decompression incision had the least rate of skin necrosis and infection. For cases combining soft tissue defect, the treatment with external fixator exhibited the least occurring rate of delay-union. Repair of soft tissue defect by regional pedicular myocutaneous flap or cross-leg myocutaneous flap had the highest survival rate. No necrosis of extremities was found in cases of vessel and nerve injuries. Seven out of the 118 cases had dysfunction of the knee joint. Conclusions Any option of the treatments should not aggravate the injury to soft tissue. Ender's nail and external fixator are the first choice in the treatment of the fractures. Pedicular myocutaneous flap and cross-leg myocutaneous flap are optional to repair the soft tissue defect. It is advisable to close the wound in the first stage and performing decompression incision.

关 键 词：胫腓骨骨折 软组织损伤 骨折固定术 

分 类 号：R683.42[医药卫生—骨科学]