非扩髓带锁髓内钉固定联合皮瓣修复治疗ⅢB型胫骨开放性骨折  

Treatment of open tibial fractures of type ⅢB with unreamed locking intramedullary nails and skin flap grafting

作　　者：张强[1] 李秉胜[1] 蔡锦方[1] 

机构地区：[1]济南军区总医院骨创伤外科,济南市250031

出　　处：《中华创伤骨科杂志》2004年第6期618-620,共3页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨一期治疗ⅢB型胫骨开放性骨折的方法。方法自1999年2月～2002年2月收治16例ⅢB型胫骨开放性骨折患者,年龄19～47岁,平均27岁。皮肤软组织缺损面积为4.5cm×3cm～14cm×6cm。术前预防性使用抗生素,进行彻底清创,用非扩髓带锁髓内钉固定骨折,皮瓣或肌皮瓣转移(移植)覆盖创面。对4例伴骨缺损的患者采用自体髂骨进行植骨。结果随访6～14个月,平均9个月。所有皮瓣均成活,未出现深部感染。14例骨折在6个月内愈合,有2例在术后10个月内愈合。按Johner-Wruch标准判定功能恢复结果,优14例,良2例。结论非扩髓带锁髓内钉固定联合皮瓣修复治疗ⅢB型胫骨开放性骨折效果较好。Objective To investigate the methods for emergency treatment of open tibial fractures of type ⅢB. Methods From February 1999 to February 2002, 16 cases of open tibial fractures of type ⅢB (age range: 19 47 years; average age: 27 years; the skin defect area: 4.5cm ×3cm-14cm ×6cm) were treated with administration of antibiotics, debridement, stabilization by unreamed locking intramedullary nails, and finally transfer or transplantation of cutaneous or musculo cutaneous flaps. Autografting from the iliac crest was done for 4 cases with bone defects. Results The follow ups averaged 9 months (ranging from 6 months to 14 months). The survival rate of flaps was 100%and all were free of deep infection. All fractures healed within 6 months in 14 patients and within 10 months in 2 patients. According to the Johner Wruchs method, the functions of ankle and knee were excellent in 14 cases, and good in 2 cases. Conclusion Emergency management of open tibial fractures of type ⅢB with unreamed locking intramedullary nails and skin flap grafting results in good outcome.

关 键 词：胫骨开放性骨折 骨折固定术 非扩髓带锁髓内钉 外科皮瓣 

分 类 号：R687.3[医药卫生—骨科学]