双臂外固定架与有限内固定修复胫腓骨中下段开放性骨折:断端固定可靠  

Bilateral external fixation combined with limited internal fixation in the repair of open fractures of middle and distal tibia and fibula: reliable fixation on the broken ends

作　　者：刘建[1] 田宝方[1] 王文珠[2] 郑卫东[1] 冯立[1] 杜宝印[1] 田大为[3] 

机构地区：[1]济宁市第一人民医院急诊外科,山东省济宁市272100 [2]济宁市第一人民医院麻醉科,山东省济宁市272100 [3]湖北医药学院附属东风医院,湖北省十堰市442000

出　　处：《中国组织工程研究》2015年第39期6350-6354,共5页Chinese Journal of Tissue Engineering Research

基　　金：湖北省教育厅课题:计算机辅助设计管状骨骨折复位器导向器及生物力学测试;编号:B20112102~~

摘　　要：背景:胫腓骨开放性骨折是四肢长骨中最易出现的骨折,单纯外固定常难以实现彻底有效的复位和固定,而切开复位内固定的缺点突出表现在术后并发症高发,严重影响关节功能的恢复,因此将外固定与内固定方法相结合修复胫腓骨开放性骨折目前在临床上应用比较多。目的:探讨胫腓骨中下段开放性骨折采用双臂外固定架结合有限切开内固定的修复效果。方法:回顾性分析济宁市第一人民医院2009年1月至2013年1月收治的56例经X射线检查或CT影像学检查确诊为胫腓骨中下段开放性骨折患者的临床资料,作为治疗组,患者均在入院8 h内进行彻底清创、复位骨折断端并进行有限内固定、固定双臂外固定架及Ⅰ期缝合,待损伤局部条件允许行Ⅱ期植皮、邻近肌皮瓣或游离皮瓣闭合修复创面。观察其修复效果及术后并发症发生情况,并与44例同期行单纯切开复位内固定修复胫腓骨中下段开放性骨折的患者(对照组)进行对比。结果与结论:治疗组56例患者中,疗效优35例,良16例,可4例,差1例,优良率为91%;对照组44例患者中,疗效优23例,良10例,可7例,差4例,优良率为75%,治疗组优良率显著高于对照组(P<0.05)。两组患者在手术切口长度、手术时间、骨折愈合时间、骨不连发生率方面差异均有显著性意义,治疗组均优于对照组(P<0.05)。提示采用双臂外固定架结合有限切开内固定修复胫腓骨中下段开放性骨折断端固定可靠,可显著降低单纯内固定引起的术后并发症,促进骨折愈合,有利于患肢及早进行恢复性训练。BACKGROUND： Open fracture of tibia and fibula is a common fracture of long bones. Simple external fixation is often difficult to achieve thorough and effective reduction and fixation. Shortcomings of open reduction and internal fixation highlighted in the high incidence of postoperative complications, and seriously affected the recovery of joint function. Therefore, external fixation combined with internal fixation for repair of open fractures of tibia and fibula has been extensively used in the clinic. OBJECTIVE： To explore the repair efficacy of bilateral external fixation combined with limited internal fixation on open fractures of middle and distal tibia and fibula. METHODS： Clinical data of 56 patients, who were identified by X-ray or CT examination and were diagnosed as having open fractures of middle and distal tibia and fibula in the Jining No.1 People＇s Hospital, as the treatment group, were retrospectively analyzed from January 2009 to January 2013. Patients were subjected to thorough debridement, reduction of the fracture fragments, limited internal fixation and fixed bilateral external fixation within 8 hours. They received stage I suture. When the local conditions of the wound permitted, they received stage II grafting, and were repaired with adjacent muscle flap or free flap. The efficacy and postoperative complication were observed. Above data were compared with those of 44 patients with open fractures of middle and distal tibia and fibula who received reduction and internal fixation（control group）. RESULTS AND CONCLUSION： Among the 56 patients in the treatment group, the outcomes were excellent in 35 cases, good in 16 cases, average in 4 cases and poor in 1 case. The excellent and good rate was 91%. Among the 44 patients in the control group, the outcomes were excellent in 23 cases, good in 10 cases, average in 7 cases and poor in 4 cases. The excellent and good rate was 75%. The excellent and good rate was significantly higher in the treatment group than that of the control group（

关 键 词：胫骨骨折 腓骨骨折 外固定器 内固定器 骨折固定术 骨科植入物 骨植入物 胫腓骨骨折 外固定架 有限内固定 开放性骨折 

分 类 号：R318[医药卫生—生物医学工程]