外固定支架在胫骨近端骨折中的应用  

Application of external fixator in the treatment of proximal tibial fracture

作　　者：常晓[1] 张保中[1] 张万利[1] 张嘉[1] 高鹏[1] 邹雄飞[1] 唐璜[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院骨科,北京100730

出　　处：《中华骨与关节外科杂志》2017年第4期321-325,共5页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:目前,对于软组织条件允许的胫骨近端病例,多应用内固定治疗,如MIPPO,但费用高昂,而且由于胫骨近端软组织覆盖菲薄,易出现切口相关并发症。目的:使用外固定支架治疗胫骨近端骨折,分析其应用指征、手术要点以及长期随访的临床疗效。方法:回顾性分析2009年1月至2013年12月接受手术治疗的15例胫骨近端骨折患者的临床资料。男13例,女2例,年龄16~57岁,平均39.3岁;其中闭合骨折13例,开放骨折2例。应用AO分型对骨折进行分型:A2型8例、A3型2例、B1型5例。手术在全麻或椎管内麻醉下进行,采用闭合复位或有限切开复位,然后使用外固定支架对骨折进行固定。术后1、2、3、4、6、12、24个月进行随访。评估项目包括受伤至手术间隔、手术时间、失血量、住院天数、部分与完全负重开始时间、完全X线骨折线完全融合时间以及并发症情况;使用下肢骨折Iowa量表对受伤的膝关节从功能、疼痛、步态、稳定性、活动范围进行评分。结果:15例患者随访17~28个月,平均21.5个月,临床疗效满意。术后未出现切口愈合相关并发症,骨折延迟愈合或不愈合。外固定架固定时间10~18周,平均13.7周。X线片上骨折线完全融合时间为18~25周,平均21.5周。1例并发针道感染患者,经扩创及保持针道引流通畅8周后去除外固定架,钉道愈合。无神经、血管损伤并发症。根据Iowa评分,功能为优8例、良5例、可2例,优良率87%。结论:使用外固定支架固定胫骨近端骨折,可以灵活穿针与构型,能够规避胫骨近端不规则的形态对内固定造成的困难,通过减少对皮肤和软组织的剥离来降低皮肤坏死和切口感染的发生;外固定支架便于对开放伤口的处理和照料,更适用于开放性骨折。术后骨折愈合率满意,功能理想,并发症率低。Background：Most proximal tibia fractures are fixed with hardware if soft tissues are available,such as MIPPO technique.But the internal hardware is expensive;and incision-related complications is uncommon and tough to handle,due to the thin envelope of soft tissue around the knee.Objective：To report the results of management of proximal tibia fractures with external fixators,and analyze the indications and key points of this method.Methods：From January 2009 to December 2013,15 patients with proximal tibia fractures were included to this retrospective study.There were 13 males and 2 females with an average age of 39.3 years （range,16 to 57 years）.All patients underwent close or limited-open reduction and fixation with hybrid extemal skeletal fixators.According to AO classification,8 patients had type A2 fracture,2 patients with type A3,and 5 patients with type B 1.Two cases of open fractures were classified to Gustilo type Ⅱ.The data were recorded,including interval from injury to surgery,operation time,perioperative blood loss,hospital stay,the time of extemal fixation,the time of bony union,and complications.The follow-up was performed in 1,2,3,4,6,12 and 24 months postoperatively.The function of knee was evaluated clinically with Iowa scale system.Results：Fifteen patients were followed up for 21.5 months on average （range,17 to 28 months）.There were no complications related to incision or soft tissue,nonunion or delayed union.The mean time of external fixation was 13.7 weeks （range,10 to 18 weeks）.The mean time of bony union on X-ray films was 21.5 weeks （range,18 to 25 weeks）.One patient suffered from a pin track infection which was healed after removal of the pin and debridement.According to the Iowa scale system,the results were excellent in patients,good in 5,and fair in 2,and the excellent and good rate was 87%.Conclusions：The extemal fixation technique can achieve a satisfactory outcome in treatment of proximal tibia fractures.The fractures can be treated immediately after the

关 键 词：胫骨近端 骨折 外固定支架 并发症 

分 类 号：R687.3[医药卫生—骨科学]