半环槽式骨外固定器治疗胫腓骨开放性骨折  

Half circle external fixation for the treatment of open tibial fibular fractures

作　　者：蔡谦 王许辉 张益波 万钧 蒋再平 彭潮 李俊 蔡卓 

机构地区：[1]益阳市第一中医医院骨科,湖南益阳413002

出　　处：《中国骨伤》2014年第3期255-257,共3页China Journal of Orthopaedics and Traumatology

摘　　要：目的：探讨半环槽式骨外固定器治疗胫腓骨开放性骨折的临床疗效。方法：2005年3月至2011年3月，经闭合手法复位或辅助克氏针撬拨复位半环槽式外固定器治疗94例胫腓骨开放性骨折患者，男63例，女31例；年龄17～65岁，平均39岁。横形骨折5例，斜形与螺旋形骨折19例，粉碎性骨折70例。骨折按Gustilo分类：ⅢA型49例，ⅢB型45例。术后观察伤口感染发生率、骨折愈合时间，并采用Johner-Wruhs评定标准对其功能进行评价。结果：所有患者获随访，时间14～63个月，平均29个月。骨折愈合时间16～39周，平均21．4周，无骨折不愈合、骨髓炎及小腿骨筋膜室综合征等并发症发生。94例中伤口I期愈合者81例，深部伤口感染者2例。功能评价采用Johner-Wruhs评定标准，优52例，良37例，中5例。结论：闭合复位或辅助克氏针撬拨复位及外固定器固定可降低胫腓骨开放性骨折感染率。对于胫腓骨开放性粉碎骨折半环槽式骨外固定器固定3～6周时根据骨折端愈合情况去除中间固定骨折块的克氏针，使支架动力化，可促进骨折愈合。Objective：To explore the effect of half circle external fixation for the treatment of open tibial fractures. Meth-ods： From March 2005 to March 2011,94 patients with open tibiofibula fractures were treated by closed manipulative or Kirschner wire poking reduction with half circle groove external fixation including 63 males and 31 females with an average age of 39 years old ranging from 17 to 65 years old. Among these patients ,5 cases were cross shaped fractures ,19 were oblique form and spiral fractures,70 cases were comminuted fractures. According to the fracture Gustilo classification,49 cases were typeⅢA,45 were typeⅢB. The incidence of wound infection,fracture healing time were observed. The function was evaluated according to the Johner Wruhs standard. Results：All patients were followed up for 14 to 63 months （averaged 29 months）. The wound healing time was from 16 to 39 weeks （means 21.4 weeks）. No fracture nonunion,osteomyelitis and calf compart-ment syndrome occurred. The wounds of 81 cases were healed at the first period ,deep wound infection occurred in 2 cases. According to the function Johner-Wruhs evaluation criteria：the result was excellent in 52 cases,good in 37 cases,fair in 5 cases. Conclusion：Closed manipulative or Kirschner wire poking reduction and half circle groove external fixation can reduce the infection rate of open tibiofibula fractures. For open tibiofibula comminuted fractures ,after the half circle groove external fixation for 3 to 6 weeks,a middle Kirschner wire was removed according to fracture end healing situation to make fixation dy-namic and promote fracture healing.

关 键 词：胫骨 腓骨 骨折 开放性 外固定器 

分 类 号：R683.42[医药卫生—骨科学]