胫骨近端闭合性粉碎性骨折环形外固定架治疗的疗效分析

目的探讨环形外固定架治疗胫骨近端闭合性粉碎性骨折的临床效果。方法选择2010-05至2012-05解放军总医院收治的胫骨近端闭合性粉碎性骨折25例，均属于闭合性骨折Tseherne分型中CⅡ型。OTA／AO骨折分型：A3型10例，C2型9例，C3型6例。均采用闭合复位或者有限切开复位骨折块后，应用Orthofixhybrid外固定架治疗。结果术后均获得随访，随访时间12～16个月，平均（13．4±3．5）个月。所有患者均获得愈合，时间为4～11个月，平均6个月。术后针道反应4例，经局部换药，口服抗生素后治愈。2例骨折延迟愈合，给予局部自体骨植骨术后愈合。末次随访时影像学RRS评分优良率80％，HSS膝关节临床功能评分优良率84％。结论利用环形外固定架治疗胫骨近端闭合性粉碎性骨折临床疗效满意。

Application of circular external fixator to treatment of closed comminuted proximal tibial fracture

Objective To study the clinical efficacy of circular external fixator in treatment of the closed and comminuted proximal tibia fracture. Methods Twenty-five patients with closed and comminnted proximal tibia fracture, including 21 males and 4 females, who were admitted to this department from May 2010 to the corresponding time in 2012 were included in this retrospective analysis. The fracture of all these patients with a mean age at 44 years belonged to C Ⅱ type according to Tscherne classification while ten of them were classified into A3 type, nine into C2, six into C3 under OTA/AO fracture classification. All the patients were treated with Orthofix hybrid external fixator after closed reduction or limited open reduction. Results All the patients were followed up and the follow-up time was between 12 and 16 months, with an average of（ 13.4 ± 3.5）months. Patients included in this research all gained bone union, however the time for full healing varied, ranging from 4 to 11 months, with a mean of six months. Four of the cases experienced needle reaction postoperatively, and were all healed by using antibiotics combined with local dressings therapy. Delayed union occurred in 2 cases and healed by bone autograft. The radiographical RRS assessment was performed during the final follow-up, which showed a 80% of the excellent rate. In addition, The excellent rate of HSS score was 84%. Conclusions Circular external fixator contributes to a satisfying outcome in treatment of the closed and comminuted proximal tibia fracture.