胫骨开放性骨折一期固定并关闭创口46例治疗体会

目的:探讨胫骨开放性骨折一期固定并关闭创口的可能。方法:按Gustilo分类标准,型10例,型27例,a型6例,b型3例,行一期固定并关闭创口,所有患者均行彻底清创,其中髓内钉固定23例,钢板固定12例,外固定架固定11例;创口直接缝合14例,局部筋膜瓣覆盖骨折处然后直接缝合皮肤5例,减张缝合15例,局部转移皮瓣12例。随访时间10个月~24个月,平均16个月。结果:46例中42例获得随访,骨折愈合38例,延迟愈合2例,不愈合2例。伤口一期愈合38例,延期愈合4例。针道感染1例,遗留下肢痛2例,踝关节活动障碍3例。结论:胫骨开放性骨折在术前术中术后有效抗生素的应用下,彻底清创后选择适当病例行一期固定并关闭创口疗效满意,值得推广应用。

A shinbone open bone fracture issue fixes and closes wounds 46 example treatment experience

Objective: To find a goal discussion shinbone open bone fracture issue and closes the wound the possibility.Methods:choice according to gustilo classification standard,Ⅰ 10 examples,Ⅱ27 examples,Ⅲa 6 examples,Ⅲ b 3 examples,a line of issue fixes and closes the wound,all patients line thorough clear creates,in which marrow nail fixed 23 examples,steel plate fixed 12 examples,outside bracket fixing fixeds 11 examples;Wounds sutures 14 examples directly,the partial fascia petal cover bone fracture place then sutures the skin 5 examples directly,reduces opens sutures 15 examples,partial shift skin petal 12 examples.Revisit time in 10～24 months,average 16 months.Results:The bone fracture heals 38 examples,retards heals 2 examples,does not heal 2 examples.A wound issue heals 38 examples,the extension heals 4 examples.The needle road infects 1 example,leaves behind the lower limb pain 2 examples,the malleolus closes the active barrier 3 examples.Conclusion:shinbone open bone fracture after technique in technique under effective antibiotic application,thorough clear creates postselection suitable sickness routine on issue to fix and to close the wound curative effect to be satisfied,is worth promoting the application.