临床治疗小腿开放性骨折的疗效分析

目的总结小腿开放骨折临床治疗经验,以提高临床疗效。方法对2000年6月～2009年6月分别采用石膏、外固定架和加压钢板治疗并得以完整随访的小腿开放骨折180例患者进行回顾分析。结果术后伤口Ⅰ期愈合148例(82%);延期愈合32例(18%)。TypeⅢB骨折皮肤缺损Ⅰ期覆盖成活18/22例(82%);Ⅱ期覆盖8例全部成活(100%)。骨延迟愈合l7例(9.4%),不愈合28例(15.6%),平均愈合时间9.5个月。不同类型骨折愈合时间差异有显著的统计学意义(χ2=59.12,P0.01)。感染15例(8.3%),Ⅰ～Ⅲ型骨折感染率分别为1.8%、3.9%和22.9%,差异比较具有统计学意义(χ2=18.48,P0.01);其中伤后6h内手术的病例发生感染3例(20%),超过6h手术的病例发生感染12例(80%),两者比较差异具有统计学意义(χ2=4.59,P0.05)。术后肢体功能和劳动力完全恢复占86%(155/180),术后发生骨筋膜室综合征5例(2.8%),Ⅰ～Ⅱ期截肢4例(2.2%)。结论小腿开放性骨折应力争早期清创,并施以满意的复位和坚强的固定。ⅢB型骨折尽量I期皮肤覆盖,消灭创面;有骨缺损时应酌情Ⅰ期植骨,并提倡积极地行Ⅰ期筋膜切开以防止骨筋膜室综合征的发生。ⅢC型骨折如保肢困难或残肢功能不全应果断地行Ⅰ期截肢,以免二次创伤或增加患者的痛苦和费用。

Clinical Outcome of Different Methods in Management of Open Fracture of Legs

Objective To improve the treatment effectives of open fracture in legs through review clinical experience. Methods 180 cases who underwent plaster fixation, external and internal fixation with DCP were retrospectively studied between June, 2000 and June, 2009. Results The wounds primary healing were 148 （82%）, delyed healing 32 （ 18% ）. The survival of primarily transplanted skin for Type Ⅲ fracture were 82%, of secondary skin graft were 100%. The average fracture healing time were 9.5 months in which delayed unions were 17 （9.4%）, nonunion 28 （15.6%）. There were no significant statistic difference for healing time among the various types （ X^2=-59.12, P〈0.01 ）. The infective rates for type Ⅰ - Ⅲ were 1.8%, 3.9% and 22.9% respectively （ X^2=-18.48, P〈0.01 ）, of that 20% occurred in operation less than 6 hours after trauma, 80% in case more than 6 hours. The compartment syndrome were 5 （2.8%）. Amputation 4 （2.2%）. Overall, the complete recovery of leg function and employment were 86%. Conclusion Early debritdement, satisfactory reduction, rigid fixation, primarily skin and bone graft for their defect and preventive decompression of doubtful department syndrome were emphasized. Meanwhile, it is advisable that Type m c fracture which is difficult to reserved or survived a painful and no function leg should be amputated primarily in case secondary trauma to the patients.