四肢开放性骨折240例早期内固定

目的：探讨四肢开放性骨折早期内固定治疗方法和疗效。方法：240例256处开放性骨折早期清创 内固定、创口一期缝合,减张缝合,转移皮瓣及肌皮瓣覆盖或延迟修复。结果：240例256处四肢开放性骨折,其中235例248处骨折病人术后随访正常骨愈合率为93%,骨延迟愈合或骨不连7%。结论：四肢开放性骨折早期彻底清创、切除污染失活组织,合理的内固定,维持骨折结构的完整性,创口合适的软组织覆盖、手术治疗效果令人满意。     

四肢开放性骨折早期内固定125例

四肢开放性骨折早期内固定 ,多年来一直有不少争论。1990年至 1995年间 ,对 12 5例四肢开放性骨折实施了早期内固定 ,现报告如下。1　临床资料男 82例 ,女 43例 ;年龄 9～ 6 5岁 ,以 2 0～ 40岁居多 ,占75 %。全部病例就诊时间均在伤后 6小时以内。骨折部位 :胫骨或胫腓骨 2 9例 ,尺桡骨 2 4例 ,股骨 17例 ,肱骨 15例 ,掌指骨 15例 ,跖骨 13例 ,踝关节 12例。伤口污染程度 :根据伤口与周围皮肤肉眼可见泥沙等异物多少与肌肉等深部软组织颜色变化分为以下四类。轻度 38例 :无肉眼可见泥沙等异物 ;中度 45例 :有少量泥沙等异物 ;较重 2 8例 :…     

治疗四肢开放性骨折150例临床小结

治疗四肢开放性骨折１５０例临床小结陆文炳，魏良熙，陈大强开放性骨折的特点是有感染伤口、均有不同程度的软组织损伤、临床处理的方法很不一致。我院自８９年～９２年共收治１５０例四肢开放性骨折，临床小结如下。１．临床资料１．１年龄与性别男１０５例，女４５例，...     

小儿四肢骨干开放性骨折并多发伤的治疗

多发性和多系统的创伤仍是目前急救医学研究的重要课题之一[1 ] ,我院从 1990年 5月～ 2 0 0 0年 5月共收住小儿四肢骨干开放性骨折并多发伤 48例 ,现报告如下。临床资料一、一般资料　本组男性 2 7例 ,女性 2 1例 ,年龄 5～ 14岁 ,平均为 8.5岁。致伤原因有 :交通伤 19例 ,高处坠落 14例 ,挤压伤 12例 ,其他伤 3例。按Ｇｕｓｔｉｌｏ分类 ,Ⅰ类 12例 ,Ⅱ类 2 7例 ,Ⅲ类 9例。受伤后到入院时间 ,8ｈ内 2 4例 ,8～ 12ｈ18例 ,12ｈ以上 6例 ,入院时有休克 3例 ,合并伤漏诊 3例 (分别为股骨颈骨折、锁骨骨折、肋骨骨折各 1例 ) ,延误诊断 1例 (…     

自动加压器治疗四肢骨折50例

自动加压器治疗四肢骨折５０例广东省梅县人民医院（５１４０１１）章生明，温吉生我院自１９９１～１９９２年用自动加压器治疗四肢骨干各类型骨折５０例，取得了满意的效果，报告如下。临床资料５０例中，男３６例，女１４例；年龄最大５９岁，最小１８岁；车祸伤３８例...     

分期微创治疗胫腓骨开放性骨折

目的 介绍胫腓骨开放性骨折的分期微创治疗经验。方法采用急性期临时使用石膏、跟骨牵引或外固定支架，待伤口稳定后采用微创技术，应用非扩髓交锁髓内钉或经皮插入钢板技术治疗胫腓骨开放粉碎性骨折72例。Gustil0分类Ⅰ度22例、Ⅱ度39例、ⅢA度11例。近端9例、中段4l例、远端22例。结果72例患者均得到随访，伤口愈合情况良好，骨折无延迟愈合、畸形愈合，平均临床愈合时间为15周。根据Johner-Wruhs评分优良率89％。结论胫腓骨开放骨折可采用分阶段治疗，早期以软组织处理为主，二期以骨折微创内固定、关节功能锻炼为主。     

开放性Pilon骨折的治疗

我院1998～2004年共治疗开放性Pilon骨折29例,疗效满意。1材料与方法1.1病例资料本组29例,男18例,女11例,年龄25～67岁。高处坠落伤15例,交通事故伤14例;其中27例合并腓骨骨折。受伤至手术清创固定时间为50min～6h。根据Ruedi-Allgower骨折分型方法:Ⅱ型7例,Ⅲ型22例。开放性骨折按Gustilo分型:Ⅰ度12例,Ⅱ度11例,Ⅲ度6例。1.2治疗方法行急诊清创缝合并同时行内固定。常规清创,先于腓骨后的小腿外侧切口复位选用加压钢板或1/3半管形钢板固定,恢复腓骨的长度。再于小腿前内侧创口或切口显露胫骨下端关节面的骨折,重建关节面后,用螺钉、克氏…     

非扩髓带锁髓内钉治疗开放性胫腓骨骨折

2004年3月~2005年11月,我科使用非扩髓带锁髓内钉治疗开放性胫腓骨骨折18例,效果满意。1材料与方法1.1病例资料本组18例,男12例,女6例,年龄21~65岁。胫骨的解剖分区:Ⅲ~Ⅴ区17例,Ⅵ区1例;骨折类型按Gustilo评定系统分为:Ⅰ型7例,Ⅱ型5例,ⅢA型5例,ⅢB型1例。急诊手术8例,10例伤     

跟骨关节内骨折内固定疗效分析

目的探讨跟骨关节内骨折切开复位内固定治疗的临床效果。方法对59例跟骨关节内骨折患者（76足）经跟骨外侧L形切口解剖型跟骨钢板内固定治疗,术前术后进行放射学评估,术后1年临床评估采用Maryland足部评分系统。结果 59例均获随访,时间6-36（24±10.5）个月。患者B hler角与Gissane角均恢复至正常范围。足部评分：优38足,良24足,中11足,差3侧,优良率为81.6%。结论掌握好手术指征和手术时机,解剖复位,早期功能锻炼,切开复位内固定治疗跟骨关节内骨折可以取得满意的疗效。     

Classification and management of acute wounds and open fractures

Acute traumatic wounds and open fractures potentially cause significant morbidity and loss of function. Much of the management of these types of injuries has been developed from the experience of military surgeons during times of armed conflict. The approach to management should start on initial assessment using trauma resuscitation protocols. Once life-threatening injuries have been managed, the wound should be thoroughly debrided and the skeleton stabilized. In the presence of heavy contamination, the wound must be re-inspected after 48 hours to evaluate whether further debridement is necessary and plans for soft tissue coverage can be made. The approach to management of open fractures should be systematic, involving both orthopaedic surgeons and plastic surgeons from the outset.     

捆绑带治疗四肢粉碎骨折

目的探讨捆绑带治疗四肢粉碎骨折的疗效。方法应用捆绑带治疗四肢粉碎骨折28例。闭合性骨折18例,开放性骨折10例(GustiloⅠ、Ⅱ型6例,Ⅲ型4例)。结果28例随访6个月～3年6个月,平均1年8个月。骨折正常愈合25例,延迟愈合3例,无骨感染发生。结论捆绑带适合治疗四肢粉碎骨折,尤其是长斜型粉碎骨折及老年骨质疏松患者,且固定可靠,手术简单,骨愈合率高,并发症少。     

Classification and management of acute wounds and open fractures

Acute traumatic wounds and open fractures potentially cause significant morbidity and loss of function. Much of the management of these types of injuries has been developed from the experience of military surgeons during times of armed conflict. The approach to management should start on initial assessment using trauma resuscitation protocols. Once life-threatening injuries have been managed, the wound should be thoroughly debrided and the skeleton stabilized. The wound must be re-inspected after 48 hours to evaluate whether further debridement is necessary and plans for soft tissue coverage can be made. The approach to management of open fractures should be systematic, involving both orthopaedic surgeons and plastic surgeons from the outset.     

非扩髓交锁髓内钉治疗开放性胫骨干骨折

目的:评估非扩髓交锁髓内钉治疗开放性胫骨干骨折的疗效。方法:应用非扩髓交锁髓内钉治疗21例开放性胫骨干骨折。男18例,女3例,年龄23岁～59岁,平均36.3岁。AO/ASIF分类A型10例,B型9例,C型2例。Gustilo分类Ⅰ型9例,Ⅱ型11例,ⅢA型1例。结果:所有患者得到4～21个月随访(平均14.3个月)。所用髓内钉直径平均8.9mm。骨折平均愈合时间27周(13～34周)。采用Johner-Wruh评分,结果优14例,良6例,差1例,无感染,无断钉和骨不连。结论:非扩髓交锁髓内钉治疗开放性胫骨干骨折,只要严格掌握适应证和手术时机,彻底清创,熟练掌握操作技术,具有创伤小、能早期活动、骨折愈合率高和感染率低等优点。     

Classification and management of acute wounds and open fractures

Open fractures and traumatic wounds represent a surgical challenge due to the risk of infection. At the extreme this is life and limb threating, but more commonly, it limits the options for reconstructions which can have functional implications for a patient. The treatment of these wounds requires removal of contamination and non-viable tissue in order to minimize further tissue damage. A wound bed of healthy tissue is essential for microbial eradication. In high energy and complex wounds associated with fractures, treatment requires a combined orthoplastic approach. Initial surgical treatment is an urgent priority and must involve senior surgeons from both specialties. This combined approach maximizes potential for reconstruction and rehabilitation while minimizing risk infection and amputation. However, this combined approach requires significant resources. Therefore, these injuries should be managed in appropriately staffed and resourced specialist centres, in practice this normally means treatment in a major trauma centre.     

Classification and management of acute wounds and open fractures

Open fractures and traumatic wounds represent a surgical challenge due to the risk of infection. At the extreme this is life and limb threatening but, more commonly, this limits options for reconstruction - which can have severe functional implications for a patient's rehabilitation. The treatment of these wounds requires removal of contamination and non-viable tissue in order to minimize further tissue damage, which has been covered by a series of guidelines developed by the British Orthopaedic Association. In high energy and complex wounds that are associated with fractures, treatment requires a combined Orthopaedic and Plastic Surgery approach. Initial surgical treatment is a priority and must involve senior surgeons from both specialties. This combined approach maximizes potential for reconstruction and rehabilitation while minimizing risk of infection and amputation; however, this combined approach also requires significant resources. These injuries should be managed in specialist centres, appropriately staffed and resourced, as facilitated by Major Trauma Centres.