开放Logsplitter骨折的分期复位内固定治疗  

Staged reduction and internal fixation for open Logsplitter fractures

作　　者：王丙刚[1] 刘娜[1] Wang Binggang;Liu Na(The Fifth Department of Trauma,The Second Hospital of Tangshan,Tangshan,Hebei 063000,China)

机构地区：[1]唐山市第二医院创伤五科,河北唐山063000

出　　处：《创伤外科杂志》2021年第12期944-947,共4页Journal of Traumatic Surgery

摘　　要：目的分析分期复位内固定治疗Logsplitter骨折的效果。方法回顾性分析唐山市第二医院创伤五科2015年1月—2019年12月收治的18例进行分期复位内固定的开放Logsplitter骨折患者的临床资料,其中男性16例,女性2例;年龄20~77岁,平均48.1岁;左侧8例,右侧10例;致伤原因摔伤4例,道路交通伤5例,重物砸伤5例,高处坠落伤3例,机器挤压伤1例。Ⅰ期清创缝合伤口,术后待软组织条件好转后,Ⅱ期行腓骨骨折、外踝骨折或者下胫腓分离切开复位内固定,并随访观察术中出血量、骨折愈合时间、踝关节活动度、美国足与踝关节协会(AOFAS)踝与后足功能评分以及伤口愈合情况。结果Ⅰ期手术术中出血量(50.6±11.6)mL,Ⅱ期手术术中出血量(62.2±11.7)mL,骨折愈合时间平均(3.7±0.8)个月,术后1年踝关节背伸度数(12.2±6.2)°、踝关节屈曲度数(28.3±8.6)°、AOFAS功能评分(83.3±5.9)分,优2例,良14例,可2例,AOFAS功能评分的优良率88.9%(16/18)。内踝伤口获得Ⅰ期愈合15例,发生皮缘坏死1例,发生皮缘坏死合并感染1例,伤后因皮肤缺损行游离植皮1例。外踝伤口获得Ⅰ期愈合17例,发生严重骨髓炎1例。结论应用分期复位内固定治疗开放Logsplitter骨折,术后伤口发生感染及坏死率较低,效果良好。Objective To analyze the effect of staged reduction and internal fixation in the treatment of Logsplitter fracture.Methods A retrospective analysis was performed on the clinical data of 18 patients with open Logsplitter fracture treated by staged reduction and internal fixation in the Fifth Department of Trauma of the Second Hospital of Tangshan from Jan.2015 to Dec.2019,including 16 males and 2 females.Their ages ranged from 20 to 77 years,with an average of 48.1 years.There were 8 cases on the left and 10 cases on the right.Causes of injury:falling injury in 4 cases,road traffic injury in 5 cases,heavy object injury in 5 cases,high falling injury in 3 cases and machine crush injury in 1 case.After the improvement of soft tissue condition,the fibula,lateral malleolus fracture or lower tibiofibular separation were treated with open reduction and internal fixation again,and the intraoperative bleeding,fracture healing time,ankle range of motion,ankle and hindfoot function score of American Foot and Ankle Association(AOFAS)and wound healing were observed.Results The intraoperative bleeding during the first operation was(50.6±11.6)mL,during the second operation was(62.2±11.7)mL,the fracture healing time was(3.7±0.8)months,the ankle dorsiflexion degree was(12.2±6.2)°,and the ankle flexion degree was(28.3±8.6)°.The AOFAS score was(83.3±5.9)points,excellent in 2 cases,good in 14 cases,fair in 2 cases,and the excellent and good rate of AOFAS score was 88.9%(16/18).There were 15 cases of primary healing of medial malleolus,1 case of skin edge necrosis,1 case of skin edge necrosis and infection,1 case of skin defect after trauma treated by skin autografting,17 cases of primary healing of lateral malleolus,and 1 case of severe osteomyelitis.Conclusion Staged reduction and internal fixation in treating open Logsplitter fractures has low postoperative wound infection and necrosis rate,and can obtain excellent rate.

关 键 词：Logsplitter骨折 分期治疗 内固定 

分 类 号：R683.42[医药卫生—骨科学]