低温环境下羊肢体枪伤骨折早期三种固定方法的疗效对比

目的对比观察低温环境下羊肢体枪伤骨折后,采用三种不同固定方法的疗效。方法新疆绵羊15只,置于野外-25℃低温环境3h后,以77式手枪枪击一侧小腿,致胫骨中段骨折,伤后6h清创,骨折分别采用石膏外固定、外固定器固定和钢板内固定,然后连续观察伤口、骨折愈合和伤肢膝关节活动情况。结果钢板内固定组伤口愈合好,无感染;石膏及外固定器固定组,部分伤口及外固定针道有分泌物,培养有细菌生长。X线片见钢板内固定组骨折对线对位及愈合最好,外固定器组次之,石膏固定组最差。病理观察三个组均无骨髓炎,相比之下钢板内固定组骨生长及骨重建最快,石膏组最慢。骨折固定方法对肢体关节活动度及肌萎缩的影响,石膏组最大,钢板内固定组最小。结论低温环境下肢体枪伤骨折早期钢板内固定并一期闭合伤口,不仅不会增加伤道感染,相反还可以防止感染的发生,有利于伤口及骨折的愈合。

Comparative study of three fixation ways in primary treatment of sheep limb fracture by gunshot in hypothermic environment

Objective To observe effect of three fixation ways in the primary treatment of sheep limb fracture by gunshot in cold and dry environment.Methods Fifteen sheep were exposed to wild ground and kept in-25 Celsius degrees＇ hypothermic environment for 3 hours,and then one side hind limb was wounded to fracture in the middle part of tibia with type 77 handgun.The wound tracks were debrided in 6 hours after injury,and the fractures were fixed by plaster cast,external fixator and plate respectivly.The condition of wound,joint activity and fracture healing were observed then.Results The wound healling were good without infection in the plate fixation group.There was secretion in some of wound and in pin hole of external fixator in the plaster fixation group and the external fixator group,and bacteria were positive in the cultivation.In X-ray,the diaplasis and healing of the fractures in the internal plate fixation group were better than that of the other groups,and the plaster fixation group had the worst outcomes.There was no postoperative osteomyelitis under the pathological observation in the three groups.The new bone growth and reconstruction in the plate fixation group were faster than that of the other groups,and the slowest was in the plaster fixation group.The influence on limb joint activity and amyotrophy were less in the plate fixation group than in the other groups,and the most influence was in the plaster fixation group.Conclusion It does not increase the wound infection rate and favore healing of wound and fracture that gunshot limb fracture in hypothermic environment is treated with internal plate fixation and primary closure of tract after early debridement.