胫腓骨开放骨折合并动脉损伤的治疗

目的 探讨合并血管损伤胫腓骨开放骨折的治疗方法。方法 回顾分析86例（均为单侧肢体）胫腓骨开放骨折合并动脉损伤（Gustilo Ⅲc型）的患者，其中胫前动脉损伤64例，胫后动脉损伤8例，两动脉同时损伤14例。结果 86例全部行急诊清创，血管探查和（或）修补。31例急诊行钢板螺钉内固定术，其中18例术后感染，6例因肢端坏死而截肢；42例行石膏外固定，其中5例术后感染，1例因肢端坏死而截肢；5例行跟骨牵引；8例行外固定架治疗。结论 合并动脉损伤的胫腓骨开放骨折，早期彻底清创至关重要。血管损伤应急诊予以修复，骨折不宜一律内固定。可利用的软组织无张力地覆盖骨、肌腱及血管，残余创面留待Ⅱ期闭合。

Treatment of open fracture of tibia and fibula complicated with artery injury

Objective To study the treatment of open fracture of tibia and fibulia with arterial injuries. Methods Eighty-six patients associated with artery injury requiring vascular repair were treated. Involved vascular were anterior tibia artery(64 cases), posterior tibia artery(8 cases),both anterior and posterior tibia artery(14 cases) . Results All the patients were performed meticulous debridement and vessel repaired. Among 31 patients treated by internal fixation, 18 cases of the patients had postoperative infection and 6 patients were performed amputation; Among 42 patients treated by plaster stabilization, 5 cases of the patients had postoperative infection and 1 patient was performed amputation;Besides,8 patients were treated by external fixation;5 patients were treated by calcaneal tractioin. Conclusion Early complete debridement is all important on open fracture of tibia and fibulia with arterial injury. Internal fixation is not recommended. When there is any question about contamination, the wound should be open better.