组合式钉棒系统外固定支架治疗儿童胫骨开放性骨折的疗效分析  

Treatment of open tibial fractures in children with composite pin-rod external fixation

作　　者：邓书贞 付喆 王侃[1] 陈兆强 魏武增 杨建平 张中礼 Deng Shuzhen;Fu Zhe;Wang Kan;Chen Zhaoqiang;Wei Wuzeng;Yang Jianping;Zhang Zhongli(Department of Pediatric Orthopeadics,Tianjin University,Tianjin 300211,China)

机构地区：[1]天津大学天津医院小儿骨科,天津300211

出　　处：《中华创伤骨科杂志》2023年第2期136-141,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨组合式钉棒系统外固定支架治疗儿童胫骨开放性骨折的疗效。方法回顾性分析2019年1月至2021年12月天津大学天津医院小儿骨科应用组合式钉棒系统外固定支架治疗的21例儿童胫骨开放性骨折患者资料。男15例,女6例;左侧9例,右侧12例;手术时年龄为(8.6±4.1)个月。骨折根据Gustilo-Anderson分型:Ⅰ型3例,Ⅱ型12例,ⅢA型3例,ⅢB型1例,ⅢC型2例。20例合并腓骨骨折;3例多发伤,3例节段型骨折。手术均急诊清创后复位骨折并以钉棒系统外固定支架组合成三角形固定,条件允许者一期闭合伤口,术后未辅助其他外固定。评估伤口愈合情况、骨折愈合及带架时间,膝、踝关节活动度及功能,并发症发生情况。结果21例患者术后获(20.7±15.8)个月随访。18例患者一期闭合伤口;3例清创、反取皮后负压引流技术覆盖:其中2例顺利愈合,1例并发浅表感染,为GustiloⅢC型,最终行股前外侧皮瓣治疗。20例骨折愈合满意,戴架时间(4.5±1.7)个月。末次随访时患侧膝、踝关节活动度与健侧相比差异均无统计学意义(P>0.05)。末次随访时根据Johner-Wruhs评价标准评定功能:优16例,良4例。1例骨折未愈合,为皮瓣手术患儿,再次行骨折手术愈合后又发生再骨折,Johner-Wruhs评价标准为差。9例出现针道感染,经治疗后愈合,无其他并发症发生。结论组合式钉棒系统外固定支架治疗儿童胫骨开放性骨折疗效满意,其操作简单,固定稳定,允许术后早期康复,对于伤口一期闭合者可作为终末治疗。Objective To explore the clinical efficacy of composite pin-rod external fixation in the treatment of open tibial fractures in children.Methods The clinical data were retrospectively analyzed of the 21 pediatric patients with open tibial fracture who had been treated at Department of Pediatric Orthopeadics,Tianjin University by composite pin-rod external fixation from January 2019 to December 2021.There were 15 boys and 6 girls,and 9 left sides and 12 right sides.The age at the time of operation was(8.6±4.1)months.According to the Gustilo-Anderson classification,there were 3 cases of typeⅠ,12 cases of typeⅡ,3 cases of typeⅢA,1 case of typeⅢB,and 2 cases of typeⅢC.Twenty cases had a concomitant fibular fracture,3 cases multiple injuries,and 3 cases a segmental fracture.All the operations were performed at the emergency department.After debridement,the fractures were reduced and immobilized with a triangle external fixation of composite pin-rod system.In the patients whose conditions permitted,the wounds were closed at one stage,and no other external fixation was added after operation.Wound healing,fracture healing,frame time,knee and ankle functional results and complications were evaluated.Results All patients were followed up for(20.7±15.8)months.Primary wound closure was achieved in 18 cases;the wound was covered by vacuum sealing drainage after debridement and reverse skin removal in the other 3 cases,of which 2 healed smoothly,and 1 was complicated with superficial infection of Gustilo typeⅢC treated eventually by an anterolateral thigh flap.Fractures healed satisfactorily in 20 cases,with a frame time of(4.5±1.7)months.At the last follow-up,there was no significant difference in the range of motion of the knee and ankle joints on the affected side compared with the uninjured side(P>0.05).According to the Johner-Wruhs evaluation criteria,the functional recovery was excellent in 16 cases and good in 4 cases.Fracture nonunion happened in one child after skin flap operation,but fracture occurred a

关 键 词：胫骨骨折 骨折固定术 儿童 外固定器 

分 类 号：R726.8[医药卫生—儿科]