外固定支架结合损伤控制理念治疗四肢开放性骨折病例对照研究

目的 :探讨外固定支架结合损伤控制骨科理念在四肢开放性骨折患者救治中的临床应用和疗效。方法 :将2008年5月至2013年1月收治的72例四肢开放性骨折患者(均未合并休克)分为对照组和观察组(各36例)。观察组男22例,女14例,进行Ⅰ期外固定支架治疗,待患者生理状况好转后尽早实施Ⅱ期骨折确定性手术;对照组男24例,女12例,在Ⅰ期切开复位下行内固定治疗。观察比较两组入院时间,开放骨折严重度评分(open fracture severity score,OFSS),手术时间,手术出血量,术中X线暴露次数,骨痂出现时间,骨折愈合时间,术后感染率,并发症发生率及恢复疗效等。结果:所有患者获随访,时间8~12个月,平均10.4个月。观察组平均手术时间(56.79±8.87)min,手术出血量(216.16±18.21)ml,骨痂出现时间(5.32±0.71)周,骨折愈合时间(12.79±2.52)周;结果优33例,良2例,差1例;并发骨折不愈合1例,局部感染1例。对照组平均手术时间(104.53±9.28)min,手术出血量(439.93±14.65)ml,骨痂出现时间(4.97±1.26)周,骨折愈合时间(14.81±2.63)周;结果优25例,良6例,差5例;并发骨折不愈合1例,局部感染8例。观察组手术时间、骨折愈合时间短于对照组,骨痂出现时间长于对照组,手术出血量少于对照组。两组OFSS评分和X线暴露次数比较差异无统计学意义。结论:对于未合并休克的严重四肢开放性骨折患者,采用外固定支架进行损伤控制治疗,能缩短手术时间,减少出血量,降低感染率和并发症,提高手术成功率及康复率,值得在临床中推广应用。

Application of external fixator combined with damage control treatment for open fracture of the extremities

Objective:To investigate the application and effects of external fixator under the guidance of damage control therapy in limb open fracture. Methods:From May 2008 to January 2013,72 cases with severe limb open fractures (Unincorporated shock) were divided into control group and observation group (36 cases in each group). In observation group,36 patients (including 22 males and 14 females) were treated by external fixator at stage I,as soon as possible after waiting for patients physiology conditions being stable,the stage II fracture operation was performed. In control group,36 patients (24 males and 12 females) were treated by the first stage open reduction. The hospital admission time,open fracture severity score (OFSS),operation duration,operative blood loss,X-ray expose times,callus appear time,fracture healing time,postoperative infection rate,complications and Johner-Wruhs accceccment were recorded and evaluated. Results:All patients were followed up for 8 to 12 months (10.4 in averaged). The mean operation duration,operative blood loss,callus appear time,fracture healing time the mean operation duration reespectively were (56.79±8.87) min,(216.16±18.21) ml,(5.32±0.71) weeks,(12.79±2.52) weeks in observation group,and (104.53±9.28) min,(439.93±14.65) ml,(4.97±1.26) weeks,(14.81±2.63) weeks in control group. According to Johner-Wruhs accceccment,there were were 33 cases in excellent,2 in good,and 1 in poor in observation group,non-union of fracture in 1 case,local infection occurred in 1 cases;in control group 25 cases in excellent,6 in good,and 5 in poor,non-union of fracture in 1 case,local infection occurred in 8 cases. There were significant differences in operation duration,operative blood loss,callus appear time,fracture healing time,postoperative infection rate,complications(P<0.05). There were no significant differences in hospital admission time,open fracture severity score and X-ray expose times(P>0.05). Conclusion:Under the guidance of damage control therapy,using external fixator measures to treat patients with open fractures of limbs is worth popularizing in clinical application because it can shorten the operation time,less blood loss,reduce the infection rate and complications,improve the success rate of surgery and recovery rate.