复杂性胫腓骨骨折137例

目的:探讨复杂性胫腓骨骨折治疗中骨折与软组织损伤处理的方法。方法:对137例复杂性胫腓骨骨折的治疗进行分析,其中胫腓骨多段骨折89例,伴有软组织缺损的胫腓骨开放粉碎骨折 27例,合并血管神经损伤的胫腓骨骨折 21例。有118例获得 10个月～5年 2个月的随访,平均随访2年 3个月。结果:胫腓骨多段骨折治疗中,以 Ender钉固定组发生骨折延迟愈合最少,Ⅰ期闭合伤口同时行减张切口减压组,皮肤发生坏死及感染机会最少。伴有软组织缺损的胫腓骨开放粉碎骨折治疗中,以外固定支架固定组发生骨折延迟愈合最少,软组织缺损修复以局部带蒂肌皮瓣及交腿肌皮瓣成活率最高。合并血管、神经损伤的胫腓骨骨折组无肢体坏死发生。全部118例中,仅7例有膝关节障碍。结论:复杂性胫腓骨骨折软组织损伤的处理与骨折本身的处理有同等重要的意义,任何治疗措施的选择都要以能避免进一步加重软组织损伤为前提。骨折以 Ender钉及外固定支架治疗为首选,软组织缺损以局部带蒂肌皮瓣及交腿肌皮瓣修复为主要方法,伤口以Ⅰ期闭合同时行减张切口减压为宜。

Treatment of 137 cases of complex tibial and fibular fractures

Objective:To find the optimal scheme on the basis of analysis of the treatment of complextibial and fibular fractures. Methods: We analyzed retrospectively 137 eases of complex tibial and fibularfractures. Among them, 89 cases had multi-segment fractures of the tibia and fibula, 27 complicated withsoft tissue defect, and 21 complicated with vessel and nerve injury. Follow-up was conducted on 118 pa-tients for 10 months to 5 years and 2 months with 2 years and 3 months on average. Results: Ender's nailshowed a minimum occurring rate of delay-union of the fractures in the treatments of multi-segment frac-tures of the tibia and fibula. Closing the wound in the first stage and performing decompression incisionhad the least rate of skin necrosis and infection. For cases combining soft tissue defect, the treatment withexternal fixator exhibited the least occurring rate of delay-union. Repair of soft tissue defect by regionalpedicular myocutaneous flap or cross-leg myocutaneous flap had the highest survival rate. No necrosis of extremities was found in cases of vessel and nerve injuries. Seven out of the 118 cases had dysfunction ofthe knee joint. Conclusion: Any option of the treatments should not aggravate the injury to soft tissue,Ender's nail and external fixator are the first choice in the treatment of the fractures. Pedicular myocutane-ous flap and cross-leg myocutaneous flap are optional to repair the soft tissue defect. It is advisable toclose the wound in the first sage and perfoming decompression incision.