GustiloⅢB、ⅢC型前臂开放性骨折的临床治疗  

Clinical management of Gustilo Ⅲ B and ⅢC type open fractures of forearm

作　　者：赵维彦[1] 赵世伟[1] 张海欧[1] 邱旭东[1] 朱春雷[1] 赵炳显[1] 

机构地区：[1]北华大学附属医院手足外科,吉林省吉林市13201l

出　　处：《中华手外科杂志》2017年第6期433-435,共3页Chinese Journal of Hand Surgery

摘　　要：目的探讨利用不同方法治疗GustiloⅢB、ⅢC型前臂开放性骨折的临床疗效。方法自2006年12月至2014年6月，我们共治疗前臂开放性骨折伴严重软组织损伤患者28例，按照开放骨折Gustilo分型：ⅢB型10例，ⅢC型18例。一期钢板固定骨折9例，一期外固定支架固定骨折4例，一期外固定支架固定二期改用钢板固定骨折15例。一期关闭创口7例，一期创口开放VSD覆盖二期游离植皮或皮瓣覆盖21例。结果所有患者均获得随访，时间为12-24个月，平均17．5个月。其中1例患者术后并发骨髓炎及骨不连，经二次手术彻底清创、桡尺骨同时短缩后钢板固定，12个月后骨折愈合，其余27例患者均在术后8～14个月内愈合，平均9.3个月。术后采用Anderson前臂骨折评价标准评定：优16例，良8例，可4例。结论针对合并不同程度软组织损伤的GustilollI型前臂骨折彻底清创、合理的固定，一期或二期闭合创面，可以最大限度保留肢体，减少术后感染、骨髓炎及骨外露等发生。Objective To evaluate the clinical effects of different methods in the treatment of Gustilo I[[B and ]]IC type open fractures of forearm. Methods From December 2006 to June 2014, 28 cases of forearm open fractures with severe soft tissue injuries were treated in our department. According to Gustilo open fracture classification, 10 cases were type ⅢB and 18 cases were type ⅢC. Fractures were treated by plate fixation at first stage in 9 cases, external fixation at first stage in 4 cases, external fixation at first stage and plate fixation at second stage in 15 cases. The wounds of 7 cases were closed at first stage, and the rest 21 cases were treated by wound open with VSD coverage at first stage and free skin graft or flap coverage at second stage. Results All the patients were follow-up for 12 to 24 months with an average of 17.5 months. Postoperative osteomyelitis and bone nonunion occurred in one case which was healed 12 months after the second operation of plate fixation after complete debridement and simultaneous shortening of the radius and ulna. The healing time of other 27 cases ranged from 8 to 14 months with an average of 9.3 months. According to Anderson＇s forearm fracture evaluation standard, the results were excellent in 16 cases, good in 8 cases, and fair in 4 cases. Conclusion Complete debridement, reasonable fixation and one or two stage wound closure for the treatment of Gustilo Ⅲ type forearm fracture accompanied with different degree of soft tissue injury can maximally achieve limb salvage and reduce the occurrence of postoperative infection, osteomyelitis and bone exposure.

关 键 词：前臂 骨折 开放性 GustiloⅢ型 严重软组织损伤 

分 类 号：R687.3[医药卫生—骨科学]