胫腓骨下段开放性粉碎骨折的治疗(附20例临床报告)

目的探讨胫腓骨下段开放性粉碎骨折的综合治疗。方法20例胫腓骨下段开放性粉碎骨折采用半环槽式外固定器固定、皮瓣转移、腓骨内移、骨折端加压并同期行上干骺端骨延长等综合治疗方法。结果伤口均一期愈合，所有皮瓣均成活，骨折临床愈合平均时间19周，7例因严重骨缺损经骨折端加压并同期行上干骺端骨延长后肢体均恢复正常长度。无1例针眼感染和血管、神经损伤。临床优良率为90％(18／20)。结论a)半环槽外固定器能克服胫腓骨下段开放性粉碎骨折的治疗困难，具有立体均衡固定。刚性可调，避免肢体受压。便于再次创面处理以及同期行骨折端加压和肢体延长等优点。b)半环槽式外固定器结合皮瓣转移、腓骨内移以及骨折端加压并同期行上干骺端骨延长等综合治疗方法是胫腓骨下段开放性粉碎骨折可选择的较好治疗措施之一。

Treatment of Open Fragment Fracture of Lower Tibia and Fibula(with 20 cases report)

Objective To investigate treatments of open fragment fracture of lower tibia and fibula.Methods 20 cases with open fragment fracture of lower tibia and fibula received external fixation, transition of skin flap and fibula, compression of the fracture ends and high tibial osteotomy and extension.Results All flaps healed satisfied.The average time of the fracture union was 19 weeks.7 cases with large bone defect got normal limb length after compression of fracture ends and high tibial osteotomy and extension.There was no infection of the nail hole and injury of blood vessel and nerve reported.Conclusion a)The half-ring extental fixator showed special advantages in the treatment for open fragment fractures of lower tibia and fibula, such as muliple plane fixation and easy modification past-operatively, it also avoided skin compression and was convenient for treating the traumatic skin.The fracture could be compressed and the length could be survived by high tibial osteotomy and extension.b)External fixation combined with transition of skin flap and fibula, fracture ends compression and high tibial osteotomy and extension was a nice selection for the treatments of open fragment fractures of the lower tibia and fibula.