外固定支架分期治疗胫腓骨Gustilo Ⅲ型骨折的临床疗效观察  

Clinical Observation of External Fixation in the Treatment of Tibia and Fibula Gustilo Ⅲ Fractures

作　　者：张福田[1] 赵杰[1] 张荣峰[1] 孙新君[1] 

机构地区：[1]解放军第89医院创伤骨五科,山东潍坊261021

出　　处：《实用骨科杂志》2017年第7期589-592,共4页Journal of Practical Orthopaedics

基　　金：军队重点项目"战创伤肢体组织缺损移植与再生修复的血管化研究"(BJN13J001)

摘　　要：目的探讨应用不同类型外固定支架分期治疗胫腓骨伴有骨缺损GustiloⅢ型骨折的临床疗效观察。方法选择2012年1月至2015年1月我院收治的伴有骨缺损的胫腓骨GustiloⅢ型骨折22例,所有患者创面进行彻底清创,骨折一期给予半环形外固定支架固定,部分患者残留创面给予皮瓣、植皮处理,待局部软组织好转后,二期给予更换Ilizarov环形外固定支架固定骨折断端,进行截骨延长术治疗骨缺损。结果本组22例患者均获得随访,随访时间16~36个月(平均20个月),17例患者二期截骨延长术后一期愈合,5例患者延长断端发生偏移,拆除外固定支架再次植骨钢板内固定,术后骨折愈合。术后功能根据Johner-Wruhs评分标准,优18例,良3例,差1例,优良率为95.5%。结论不同类型外固定支架分期治疗胫腓骨伴有骨缺损GustiloⅢ型骨折,前期可有效的保护断端软组织血运,减少二次损伤,符合损伤控制理论,后期可促进肢体恢复及功能重建,是治疗GustiloⅢ型骨折理想的方法。Objective To observe the clinical effect of different types of external fixation in the treatment of tibia and fibula with Gustilo Ⅲ fracture.Methods From January 2012 to 2015 January,22 cases of Gustilo-type Ⅲ fractures with bone defects were treated in our hospital.All patients wounds were thoroughly debrided and fractures were given a semi-circular external fixation.Residual woundsweretreated with skin flap,skin grafting,local soft tissue.Ilizarov circular external fixators were used to fix fracture.Osteotomy and bone lengthening wereused to treat bone defect.Results All of the 22 patients were followed up.The follow-up time was 16 to 36 months （average 20 months）.17 patients withbone lengtheninggot boneunionwithoutoperation.In 5 cases of patients with malalignment,external fixationwas removed andpatients underwent bone grafting and plate fixation.All the patients gotbone union.According to the Johner-Wruhs score,there were 18 cases of excellent,3 cases of goodand poor in 1 cases,the excellent and good rate was 95.5%.Conclusion External fixationcan effectively protect the soft tissue blood supply and reduce the secondary injury,which isconsistent with trauma control theory.It can alsopromote the recovery of limbs and functional reconstructioninbone defect of tibia and fibula of Gustilo Ⅲ.It is an ideal fixation method for the treatment of Gustilo Ⅲ fractures.

关 键 词：外固定支架 胫腓骨 骨缺损 GUSTILO Ⅲ型骨折 

分 类 号：R683.42[医药卫生—骨科学]