三种固定方式治疗Gustilo Ⅲ A-B型开放性胫骨骨折的对比  

Comparison of three fixation techniques for open tibial fractures of Gustilo type ⅢA-B

作　　者：曾文波 李姣[3] 郝东阳 兰生辉 陈美玲 魏世隽 刘曦明 ZENG Wen-bo;LI Ji-ao;HAO Dong-yang;LAN Sheng-hui;CHEN Mei-ling;WEI Shi-jun;LIU Xi-ming(Orthopedic Department,Certral Theater Command General Hospital of PLA,Wuhan 430070,China;Department of Orthopaedics,Traditional Chinese Medicine Hospitai of Hubei Province,Wuhan 430060,China;Hankou Wangfindun Sanatorium of Air Force,Wuhan 430030,China;Wuhan Clinical College of Southern Medical University,Wuhan 510515,China;Equipment Department of the Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]中国人民解放军中部战区总医院骨科,武汉430070 [2]南方医科大学附属武汉临床学院,广州510515 [3]湖北省中医院骨科,武汉430060 [4]空军汉口王家墩干休所卫生所,武汉430030 [5]重庆医科大学附属第二医院设备处,400010

出　　处：《中国矫形外科杂志》2018年第24期2209-2214,共6页Orthopedic Journal of China

基　　金：国家自然科学基金资助项目(编号:81601902);湖北省自然科学基金项目(编号:2015CFB240);博士后科学基金项目(编号:2015M572817).

摘　　要：[目的]比较三种固定方式对GustiloⅢA-B型开放性胫骨骨折的治疗效果。[方法]回顾性分析2008年1月～2014年12月本院手术治疗的80例GustiloⅢA-B型胫骨开放性骨折患者。按治疗方法:27例采取髓内钉(UTN)一期内固定,22例接受锁定钢板(LCP)一期内固定, 31例接受外固定支架(UEF)固定。记录患者相关资料,按照Johner-Wruhs评定标准进行患肢功能评价。[结果]三组患者在创伤严重度评分(ISS)、伤口污染程度、Gustilo-Anderson分型、按骨科创伤协会OTA分型、伤口创面覆盖方式方面的差异无统计学意义(P>0.05)。手术时间和术中失血量依次为LCP组> UTN组>UEF组,三组间差异有统计学意义(P<0.05)。所有患者随访24～60个月,平均(36.37±10.96)个月。三组患者在深部感染、骨髓炎、截肢、术后6个月愈合不良和12个月不愈合发生率方面的差异无统计学意义(P>0.05)。临床骨愈合时间三组间的差异无统计学意义(P>0.05)。末次随访时,按照JohnerWruhs评定标准评定优良率,UTN组为85.19%,LCP组为81.82%,UEF组为67.74%。[结论]在严格清创、结合置管冲洗和VAC的前提下,GustiloⅢA-B型胫骨开放性骨折采用Ⅰ期内固定方式治疗可以获得满意疗效。[Objective] To compare clinical outcomes of three fixation techniques for Gustilo type Ⅲ A-B open tibial fracture. [Methods] A retrospective study was conducted on 80 patients who were surgically treated for Gustilo type Ⅲ A or B open tibial fractures from January 2008 to December 2014 in our hospital. In term of fixation applied, the fractures were fixed at one stage with locking compression plate(LCP) in 27 patients, unreamed tibial nail(UTN) in 22 patients, and unilateral external fixator(UEF) in the remaining 31 patients. The related clinical data were compared among the 3 groups, and the clinical outcomes were assessed by Johner-Wruhs criteria. [Results] There were no significant differences among the 3 groups regarding to injury severity score(ISS), wound contamination severity, Gustilo-Anderson classification, Orthopedic Traumatology Association(OTA) classification, and approaches of wound coverage(P<0.05). The operation time and intraoperative blood loss were ranked in the sequence of LCP > UTN > UEF with significant differences among them(P<0.05). The patients were followed up for 24to 60 months with a mean of(36.37±10.96) months. No significant differences were found in complications among them, such as deep infection, osteomyelitis, amputation,poor healing at 6 months and non-union at 12 months(P>0.05), and no a significant difference was proved either in fracture healing time among them(P>0.05). At the latest follow up, the excellent and good rate of clinical outcomes was85.19% for the UNT, 81.82% for the LCP and 67.74% forthe UEF based on Johner-Wruhs criteria. [Conclusion] Primary internal fixations do achieve sound clinical outcomes for Gustilo type Ⅲ A-B open tibial fractures provided that strict debridement, proper irrigation and vacuum sealing drainage(VSD) were performed.

关 键 词：开放性胫骨骨折 非扩髓胫骨髓内钉 锁定加压钢板 单侧外固定架 

分 类 号：R683.42[医药卫生—骨科学]