临时外固定支架转换内固定分期治疗胫骨干开放性骨折  

Staged conversion from temporary external fixation to internal fixation for open fractures of tibial shaft

作　　者：王欣[1] 吴华 张世民 Wang Xin;Wu Hua;Zhang Shimin(Department of Orthopaedics,Tongji Hospital,School of Medicine,Tongji University,Shanghai 200065,China;Department of Orthopaedics,The First People＇s Hospital of Jingdezhen,Jingdezhen 333000,Jiangxi China;Department of Orthopaedics,Yangpu Hospital,School of Medicine,Tongfi University,Shanghai 200090,China)

机构地区：[1]同济大学附属同济医院骨科,上海200065 [2]江西省景德镇市第一人民医院骨科,333000 [3]同济大学附属杨浦医院骨科,上海200090

出　　处：《中华创伤骨科杂志》2018年第8期661-665,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的 探讨临时外固定支架转换内固定分期治疗胫骨干开放性骨折的疗效.方法 回顾性分析自2008年10月至2016年10月我们收治的31例胫骨干开放性骨折患者资料,男20例,女11例;年龄15 ～ 79岁,平均38.7岁;按照Gustilo分型：Ⅰ型2例,Ⅱ型9例,ⅢA型17例,ⅢB型3例;胫骨干骨折按照AO/OTA分型：42A型3例,42B型10例,42C型18例.彻底清创后先行外固定支架临时固定骨折端,维持胫骨的长度和力线,其中23例直接缝合创面,8例使用负压封闭引流技术覆盖创面,待全身状况和（或）局部软组织条件恢复后,去除外固定支架,石膏维持4～7d钉道愈合后,再二期转换为确定性的内固定治疗（24例患者更换为钢板内固定,7例患者更换为髓内钉固定）.结果 所有患者术后获13 ～61个月（平均22.3个月）随访,骨折均获愈合,愈合时间14 ～31周（平均18.7周）.无一例出现伤口并发症、感染等问题.术后按照Johner-Wruhs评分：优24例,良4例,中3例,优良率为90.3％.结论 临时外固定支架转换内固定分期治疗胫骨干开放性骨折,软组织并发症低,骨折愈合率高,是一种安全、有效的治疗方法.Objective To evaluate the clinical efficacy and safety of planed conversion from temporary external fixation to internal fixation for open fractures of tibial shaft.Methods We retrospectively reviewed 31 patients with high-energy open fracture of tibial shaft who had been treated from October 2008 to October 2016 at Department of Orthopaedics,in our hospital.They were 20 males and 11 females,with an average age of 38.7 years （from 15 to 79 years）.By the Gustilo classification,2 cases were type Ⅰ,9 type Ⅱ,17 type ⅢA and 3 type ⅢB;by the AO/OTA classification,3 cases were type 42A,10 type 42B,and 18 type 42C.External fixation was temporally applied for the fracture ends after thorough debridement to recover the tibial length and alignment.The wounds were closed directly in 23 cases and covered with vacuum sealing drainage in 8.The external fixators were removed after their systemic condition and/or local condition of soft tissue recovered.After plaster casts were maintained for 4 to 7 days to allow for healing of the pin tracts,conversion into secondary definite internal fixation started.Plating was applied in 24 patients and intramedullary nailing in 7 patients.Results The 31 patients gained fellow-up from 13 to 61 months （mean,22.3 months）.All fractures gained bony union after an average of 18.7 weeks （from 14 to 31 weeks）.No wound complication or infection was observed.According to the Johner-Wruh＇s criteria,24 cases were rated as excellent,4 as good and 3 as fair,giving an excellent to good rate of 90.3%.Conclusion The staged conversion from temporary external fixation to internal fixation is effective and safe for open fractures of tibial shaft,leading to limited complications of soft-tissue and a high rate of fracture union.

关 键 词：胫骨骨折 外固定器 骨折固定术 内 骨折 开放性 损害控制 

分 类 号：R687.3[医药卫生—骨科学]