开放性胫腓骨骨折诊疗进展  

Advances in diagnosis and treatment of open tibia and fibula fractures

作　　者：何武兵[1,2,3] 陈锋 雷钦亮[1,2,3] 何雪义 朱毅仁 He Wubing;Chen Feng;tLei Qirdiang;He Xueyi;Zhu Yiren(Department of Emergency,Fujian Provincial Hosp让al,Fuzhou 350001.China;Provincial Clinical College of Fujian Medical University,Fuzhou 350001,China;Trauma Center,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建省立医院急诊外科,福州350001 [2]福建医科大学省立临床医学院,福州350001 [3]福建省创伤医学中心,福州350001

出　　处：《创伤外科杂志》2022年第6期401-407,共7页Journal of Traumatic Surgery

基　　金：福建省自然科学基金(2020J011076);福建省医学创新课题(2020CXA007);福建省卫生健康软科学研究课题(2020RK003)。

摘　　要：开放性胫、腓骨骨折常由高能量损伤所致,往往合并危及生命的多发伤,易造成软组织感染、骨不愈合等并发症。并发症的存在严重影响患者生存预后,给社会、医疗服务带来负担。作者于Pubmed、Web of science、中国知网检索相关文献,目的是总结和探讨开放性胫腓骨骨折流行病学、分型、早期评估与处理、治疗原则和策略。创伤早期遵循“快速不耽误”和“全面不遗漏”的原则,进行快速有效的评估,结合开放性损伤严重程度的分型,对危及生命的损伤进行处置,可以显著降低可预防性死亡。开放性胫、腓骨骨折的治疗策略是采用损害控制外科和损害控制复苏的理念,实施分阶段救治策略,即在急诊进行伤情评估,严格掌握截肢指征,彻底清创缝合和(或)外固定等创伤控制治疗,待病情改善后二期进行最终内固定和伤口闭合,可以明显提高开放性胫腓骨骨折的救治效果,降低伤残率和伤死率。Open fractures of the tibia and fibula are often caused by high-energy injuries,often combined with life-threatening multiple injuries,which are prone to soft tissue infection,bone nonunion and other complications.The existence of complications seriously affects the survival and prognosis of patients and brings a burden to the society and medical services.In order to summarize and discuss the epidemiology,classification,early evaluation and management,treatment principles and strategies of open tibiofibular fractures,the authors searched relevant literature in Pubmed,Web of science and CNKI.Following the principles of“fast without delay”and“complete without omission”in the early stage of trauma,rapid and effective assessment,combined with the classification of the severity of open injuries,and disposal of life-threatening injuries can significantly reduce preventable deaths.The treatment strategy for open tibia and fibula fractures is to adopt the concept of damage control surgery and damage control resuscitation,and implement a phased treatment strategy,that is,to evaluate the injury condition in the emergency department,strictly grasp the amputation indications,combined with thoroughly debridement and suture and/or external fixation and other trauma control treatments.After the condition improves,the final internal fixation and wound closure in the second stage can significantly improve the treatment effect of multiple injuries and reduce the rate of disability and death.

关 键 词：胫骨骨折 腓骨骨折 损害控制 

分 类 号：R683.42[医药卫生—骨科学]