有限内固定结合单侧多功能外固定架治疗胫腓骨严重开放粉碎性骨折

目的观察有限内固定结合单侧多功能外固定支架治疗胫腓骨严重开放粉碎性骨折的疗效。方法使用有限内固定(钢丝、螺丝钉、克氏针)结合单侧多功能外固定架固定胫骨,同时钢板、克氏针、钢丝固定腓骨治疗胫腓骨严重开放粉碎性骨折。结果本组42例随访6~24个月,平均12个月。伤口愈合情况:25例I期甲级愈合;15例皮肤发黑、坏死,经换药,皮瓣转移愈合;2例感染,经换药引流、分泌物培养、选用敏感抗生素、皮瓣转移及植皮后愈合,无一例骨髓炎。骨折愈合情况:40例于骨折术后13~32周愈合,平均18周;2例骨缺损致骨不连在伤口愈合后3个月行植骨+钢板内固定,术后3个月骨折愈合。另螺钉松动1例,松动伴钉道感染1例,经用酒精点滴钉孔痊愈,无血管、神经损伤。除1例踝关节僵直外,其余41例膝、踝关节功能正常。结论该手术操作简单,创伤小,复位好,固定可靠,是治疗胫腓骨严重开放粉碎性骨折的良好方法。

Treatment of Severe Open Fracture in Leg with Limited Internal Fixation Combined with Unilateral Multifunctional External Fixing Frame

Objective To observe the outcome of limited internal fixation combined with unilateral multifunctional external fixing frame for the treatment of severe open comminuted fracture in tibia and fibula. Methods The fractured tibia was fixed by limited internal fixation (steel wire, screw and Kirschner wire) combined with unilateral multifunctional external fixing frame, and the fractured fibula was meanwhile fixed by steel plate, Kirschner wire and steel wire. Results A total of 42 patients were followed up 6 till 24 months (average=12 months). About wound healing, 25 patients reached primary healing (Ia), 15 were healed after being performed skin flap transfer due to skin blackening or necrosis, and two experienced infection and were healed after antibiotic treatment and skin flap transfer. There was none of osteomyelitis. As for bone fracture healing, 40 patients reached healing 18 weeks (13-32 weeks) after operation. The other twos were performed bone transplantation and internal fixation (steel plate) due to malunion three months after wound healing, and got to bone fracture healing another three months after bone fracture operation. In the end, all the patients’ knee and ankle joints were functionally normal except ankle anchylosis in one patient.Conclusion Providing reliable fixation and reposition, limited internal fixation plus unilateral multifunctional external fixing frame is an excellent approach to the treatment of severe open comminuted fracture in tibia and fibula. It is easy to be performed with less wound.