重度开放性胫腓骨骨折治疗方式选择和疗效评价

目的：评价重度开放性胫腓骨骨折最佳治疗方法。方法：本组361例,387例肢体均为Ⅲ度开放性胫腓骨骨折。一期截肢14例（另一例外固定支架组延期截肢）,清创后行石膏托制动或骨牵引84侧,内固定126侧,单侧外固定支架固定162侧。结果：石膏固定或骨牵引组骨折愈合率76.8%,平均愈合时间7.6个月,浅表感染、深部感染率分别为22.4%和26.2%,远期并发症58.7%。内固定组骨折愈合率为82.5%,平均愈合时间8.4个月,浅表感染率、深部感染率为13.2%和32.4%,远期并发症48.5%。外固定支架组延期截肢1例,骨折愈合率91.2%,平均愈合时间9.1个月,浅表感染率、深部感染率为13.4%和8.5%,远期并发症23.7%。结论：外固定支架在治疗重度胫腓骨开放性骨折中能起到有效固定,减少深部感染率,减少组织再损伤,有利于肢体功能恢复的目的。

Treatment of Severe Open Fractures of Tibia and Fibula

Objective:To evaluate the treatment of severe open fractures of tibia and fibula.Methods:Three hundred and sixty one patients with 387 extremities with severe open fractures of tibia and fibula were treated:14 cases treated with amputation,84 with plaster fixator.Results:In the group of plaster fixation or skeletal traction,the union rate is 76.8% with the average union time of 7.6 months,the superficial infection rate of 22.4%,and the deep infection rate of 26.2%,and the complication rate of 58.7%.In the group of internal fixation,the union rate is 82.5% with the average union time of 8.4 months,the superficial infection rate of 13.2%,and the deep infection rate of 32.4%,and the complication rate of 48.5%.In the group of external fixator,the union rate is 91.2% with the average union time of 9.1 months,the superficial infection rate of 13.4%,and the deep infection rate of 8.5%,and the complication rate of 23.7%.Conclusion:External fixator is a good choice for severe open fractures of tibia and fibula with a lower deep infection rate and a better fuction.