早期软组织覆盖结合锁定钢板外固定治疗胫骨干GustiloⅢ型骨折的疗效分析  

Efficacy of early soft tissue coverage combined with locking plate external fixation in the treatment of Gustilo typeⅢtibial shaft fractures

作　　者：潘健 郑联合 芦斌 韩超 沙浩 Pan Jian;Zheng Lianhe;Lu Bin;Han Chao;Sha Hao(Department of Orthopedics,Tangdu Hospital of Air Force Medical University,Xi’an 710038,China)

机构地区：[1]空军军医大学唐都医院骨科,西安710038

出　　处：《创伤外科杂志》2025年第2期116-119,共4页Journal of Traumatic Surgery

摘　　要：目的分析早期软组织覆盖结合锁定钢板外固定对胫骨干GustiloⅢ型骨折的治疗效果。方法回顾性分析2014年1月—2023年12月空军军医大学唐都医院骨科采用72h内早期自身软组织覆盖,并行锁定钢板外固定的胫骨GustiloⅢ型骨折患者26例,男性19例,女性7例;年龄12~69岁,平均42.5岁;道路交通伤19例,高处坠落伤2例,管状物夹伤5例;GustiloⅢA型15例,GustiloⅢB型8例,GustiloⅢC型3例。对所有患者进行术后3、6个月、1年的随访,通过X线片及体格检查作为患者伤口愈合、骨髓炎、骨折愈合或延迟愈合的根据。根据关节活动度及膝关节HSS评分评估关节功能恢复情况。结果创面感染3例(11.5%),骨髓炎1例(3.8%),骨折不愈合2例(7.7%)。根据HSS评分问卷,患者平均得分为(86.5±13.2)分,膝关节功能优良率80.7%。结论早期软组织覆盖结合锁定钢板外固定治疗胫骨干GustiloⅢ型骨折,可有效控制感染,具有良好的骨折愈合率,患肢功能得到良好的保护。Objective To analyze the therapeutic effect of early soft tissue coverage combined with locking plate external fixation for Gustilo typeⅢtibial fractures.Methods This retrospective analysis was conducted on 26 patients with Gustilo typeⅢtibial shaft fractures,who were managed in our department from Jan.2014 to Dec.2023 by soft tissue coverage within 72 h after injury and locking plate external fixation in the end.There were 15 cases of Gustilo typeⅢA,8 typeⅢB,and 3 typeⅢC;19 males and 7 females aged 12-69(mean 42.5)years.Among them,there were 19 road traffic injuries,2 falls from height,and 5 tubular clamping injuries.All patients were followed up at 3 and 6 months and 1 year after surgery,when wound healing,osteomyelitis,and fracture healing or delayed healing were assessed by X-rays and physical examination of patients.The recovery of joint function was evaluated according to the joint mobility and Hospital for Special Surgery(HSS)score of the knee joint.Results Wound infection was reported in 3 cases(11.5%),osteomyelitis in 1(3.8%),and nonunion in 2(7.7%).The average HSS score was 86.5±13.2 and the excellent and good rate of knee joint function reached 80.7%.Conclusion Early soft tissue coverage combined with locking plate external fixation is a good choice for Gustilo typeⅢtibial fracture,which can effectively control infection,promote fracture healing,and well protect the function of the affected limb.

关 键 词：胫骨开放性骨折 清创 软组织覆盖 锁定钢板 外固定 

分 类 号：R687.3[医药卫生—骨科学]