采用Hoffmann II组合式外固定系统治疗儿童胫腓骨开放性不稳定性骨折

目的探讨HoffmannⅡ组合式外固定系统治疗儿童胫腓骨开放性不稳定性骨折的疗效。方法对12例儿童开放性胫腓骨不稳定性骨折，进行外固定支架治疗，观察骨折临床愈合时间及有无并发症发生。彻底清创后根据原有伤口的特点选择手术切口扩创。骨折复位后用可吸收线捆绑游离的骨折块，在胫骨钻入3根以上外固定针，针的位置不追求对称，尽可能地使杆一杆固定夹朝向骨折方向，连接杆也尽可能地短。C臂x线机透视下检查骨折复位情况。放置负压引流管或橡皮片，如肢体肿胀严重，可用VSD覆盖创面，二期闭合伤口。结果本组随访时间14—38个月，平均26个月。骨折骨性愈合及拆除外固定架时间5．0—6．5个月，平均5．2个月。拆除外固定系统时膝、踝关节功能基本恢复正常，骨折对位对线良好，骨折全部骨性愈合，无再次骨折的病例。3例出现针道感染，其中1级2例、2级1例，通过换药、抗生素治疗、加强护理等手段痊愈，无因针道感染发生外固定系统松动而提前拆除。按照Johner—Wruh胫骨骨折疗效评定标准，本组优良率为95％。结论彻底清创可以最大限度地减少感染源和后期的感染控制呈正相关。儿童开放性胫腓骨不稳定性骨折采用HoffmannⅡ组合式外固定系统具有创伤小、固定牢靠和并发症少等优点，是治疗儿童开放性胫腓骨骨干不稳定性骨折理想的治疗方法。

Treatment of open unstable fractures of the tibia and fibula in children with Hoffmann II compact external fixator system

Objective To investigate the efficiency of Hoffmann II compact external fixator system in the treatment of open unstable fractures of the tibia and fibula in children. Methods A total of 12 children patients with open unstable fractures of the tibia and fibula were treated with the external fixator. The clinical healing time and complications of fractures were observed. After complete debridement, whether to enlarge the incision depended on the characteristics of the original wound. The free fracture fragments were bound with absorbable sutures after fracture reduction. More than 3 external fixation pins were drilled in the tibia. It was unnecessary to keep the position of the pins symmetrical. However, the pole-pole clamp was kept towards the fracture direction as much as possible, and the connecting rod was as short as possible. The fracture reduction was examined with the C-Arm X-medical equipment. The negative pressure drainage tube or rubber sheet was placed in the incision. If the limb swelling was severe, the wound surface would be covered with Vaccum Sealing Drainage （VSD）, before second-stage closure. Results The follow-up time ranged from 14 to 38 months, with an average period of 26 months. Fracture healing time and external fixator removal time ranged from 5 to 6.5 months, with an average period of 5.2 months. The function of the knee and ankle was basically recovered to the normal when the external fixator was removed. All fractures showed good contraposition, and all patients appeared osseous healing, with no case of refracture. Pin tract infection was detected in 3 cases, in which there were 2 cases of degree I and 1 of degree II, and it was controlled with dressing change, antibiotic therapy, intensive care and so on. There was no patient whose external fixator system was removed in advance, due to its loosening caused by pin tract infection. 95% of the cases were excellent according to Johner-Wruth classification of tibia fractures. Conclusions Complete debridement can reduce the source of infection as much as possible, and there is a positive correlation between complete debridement and later infection control. The treatment of open unstable fractures of the tibia and fibula in children with Hoffmann II compact external fixator system, which has such advantages as smaller surgical trauma, rigid fixation, fewer complications and so on, is a satisfactory surgical method.