二期髌上入路髓内钉治疗胫骨近端GustiloⅢB型开放性骨折的临床疗效  

Clinical effects of secondary suprapatellar approach intramedullary nail in the treatment of proximal tibial GustiloⅢB open fracture

作　　者：刘德印 卢代刚[1] 马腾[1] 任程[1] 孙亮[1] 李忠[1] 张堃[1] 孟羿彬 LIU De-yin;LU Dai-gang;MA Teng;REN Cheng;SUN Liang;LI Zhong;ZHANG Kun;MENG Yi-bin(Department of Trauma,HongHui Hospital,Xi'an,Shaanxi,710054,China)

机构地区：[1]西安交通大学附属红会医院创伤骨科,陕西710054 [2]西安交通大学附属红会医院脊柱外科,陕西710054

出　　处：《中国骨与关节杂志》2020年第12期893-898,共6页Chinese Journal of Bone and Joint

基　　金：陕西省科技厅项目(2015SF116)。

摘　　要：目的探讨二期髌上入路胫骨髓内钉治疗胫骨近端GustiloⅢB型开放性骨折的临床疗效。方法对2013年5月至2017年6月我院采用一期清创、外固定、软组织覆盖,二期髌上入路髓内钉内固定治疗的胫骨近端GustiloⅢB开放性骨折的13例患者资料进行分析,其中男11例,女2例,年龄20~58岁,平均44.2岁。左侧5例,右侧8例。致伤原因车祸伤9例,坠落伤3例,重物压伤1例。3例患有原发性高血压,口服药物控制平稳;1例合并糖尿病,围术期行胰岛素泵治疗控制血糖。记录手术时间、术后即刻膝关节屈曲角度、术后并发症、术后1年膝关节屈曲角度、膝前疼痛视觉模拟评分(visual analogue scale,VAS),美国特种外科医院(Hospital for special surgery,HSS)膝关节功能评分评估疗效。结果所有患者均获随访,随访时间18~30个月,平均手术时间(78.4±8.9)min(65~115 min)。术后即刻膝关节屈曲角度(45.2±16.7)°。术后骨折均获愈合,骨折愈合时间平均(22.3±4.8)周(14~38周)。2例出现术后患侧小腿肌间静脉血栓形成,其他患者无明显并发症发生,术后1年膝关节屈曲角度(121±14.3)°。3例存在膝前疼痛,平均VAS评分(1.4±0.23)分。末次随访膝关节HSS评分优11例,良1例,可1例。优良率92.3%。结论对于GustiloⅢB型胫骨近端开放性骨折,采用一期清创、外固定、软组织覆盖,排除感染后二期行髌上入路胫骨髓内钉治疗,具有操作简单、并发症少、效果良好的优点,值得推广。Objective To investigate clinical effects of secondary suprapatellar approach tibial intramedullary nail in the treatment of proximal tibial GustiloⅢB open fractures.Methods From May 2013 to June 2017,13 patients(5 cases on the left;8 cases on the right)with GustiloⅢB proximal tibia open fractures underwent primary debridement,external fixation,soft tissue coverage and secondary suprapatellar intramedullary nailing.There were 11 males and 2 females with an average age of 44.2 years(range:20-58 years).Causes of injury:traffic accident in 9 cases;falling injury in 3 cases;heavy object crush injury in 1 case.Three patients with essential hypertension were treated with oral medication,and one patient with diabetes mellitus was treated with insulin pump to control blood glucose.Operation time,knee flexion immediately after operation,postoperative complications,knee flexion1 year after operation,VAS of anterior knee pain and HSS were recorded.Results All patients were followed up with an average of 18-30 months.The average operation time was(78.4±8.9)min(range:65-115 min).The knee flexion immediately after operation was(45.2±16.7)°.The average healing time was(22.3±4.8)weeks(range:14-38 weeks).No obvious complications occurred except for intramuscular venous thrombosis in 2 patients.The knee flexion 1 year after operation was(121±14.3)°.Anterior knee pain was observed in 3 patients,and the average VAS was(1.4±0.23).HSS scores at the last follow-up:excellent in 11 cases;good in 1 case;fair in 1 case;excellent and good rate 92.3%.Conclusions One-stage debridement,external fixation,soft tissue coverage,and secondary suprapatellar tibial intramedullary nailing after infection exclusion are recommended by simple operation,less complications and good effects in the treatment of proximal tibial GustiloⅢB open fracture.

关 键 词：胫骨骨折 骨折固定术 髓内 治疗效果 

分 类 号：R683.4[医药卫生—骨科学]