动力外固定支架治疗胫骨骨折的并发症分析与对策(附11例报告)

目的:探讨动力外固定支架治疗胫骨骨折并发症的处理及预防措施。方法:对动力外固定支架治疗胫骨骨折出现并发症患者11例进行回顾性分析。其中男9例,女2例,年龄17～48岁,平均27.2岁,使用动力外固定支架固定时问为1.5～13个月,平均5.4个月。其中出现感染8例;骨延迟愈合5例,骨不愈合1例,外支架断裂3例,畸形愈合2例。入院后不同的并发症予以相应处理。结果:固定过程中严格的生物力学操作可以避免固定系统因应力干扰出现螺钉松动、断裂和主体断裂;早期钉孔感染一般比较局限,通过适当的处理能够避免加重扩大;适当的动力化可以避免骨延迟愈合或骨不连。结论:外固定支架是一种具备“生物学固定”理念的骨折固定器具,如果在胫骨骨折的固定过程中由于对外支架设计理念的理解不足,会导致感染、延迟愈合或不愈合等多种并发症,可以通过术中及术后的适当处理加以避免。

Analysis and treatment of complications in tibial fracture with dynamic external fixator

Objective: To investigate the treatmentand prevention of the complications in the stabilization of tibial fracture with dynamic axial fixator. Method : Retrospectivly analyzed 11 cases with complications in fixation of tibia] fracture with DAF. Nine cases male and two female,aged from 17 to 48 years,with average age of 27.2. The stability periods with DAF from 1.5 to 13 months,with average periods of 5.4 months. Among them,8 cases suffered from infection of screw aperture,5 with delayed union,one with nonunion, 3 with breakage of fixator and two with malunion. All accepted treatment according to their complications. Result :The loosen and broken of screw and main fixator could be avoided by abiding to the biomechanical principle in the operation. The infection was local in the initial stage, and could be avoided aggravating and enlarging by appropriate disposition. Appropriate motorization could prevent the delayed-union and ununion. Conclusion:The DAF is a kind of biological device to stabilization the tibiae fracture. Mis-or lack understanding about the design principle could lead to many complications. The majority of them could be avoided by appropriate management during operation and post-operation.