骨外固定加压治疗胫骨开放性骨折(附107例报道)

目的评估骨外固定治疗胫骨开放性骨折的疗效。方法107例胫骨开放性骨折骨外固定加压治疗。将伤口彻底清创后，交叉穿针骨外固定。稳定性骨折复位后可直接加压固定。对不稳定骨端和粉碎骨块(片)整复后先用1～3枚螺钉固定，不剥离骨膜，使分离的骨折端和骨块互相靠拢以增强骨折端的稳定性。小腿中上段软组织缺损选用腓肠肌内侧头或腓肠肌肌皮瓣转位修复，中下段用邻近筋膜皮瓣覆盖。结果107例中94例伤口一期愈合(87．8％)。骨折愈合时间4．5～6．5个月，平均5个月。结论骨外固定加压是治疗胫骨开放性骨折较为理想的方法，其固定确切、操作简单，对骨生长的生物学及生物力学环境影响小，有利于骨折愈合：钢针远离骨折端，对骨端的血循环干扰小。

Treatment of open tibia fracture with compressive external fixation:a report of 107 cases

Objective To investigate the effects of the treatment of open tibia fracture with compressive external fixation. Methods 107 cases of open tibia fracture were treated with compressive external fixation. The wound was debrided meticulously and the tibia fracture was immobilized with cross pins to achieve stable external fixation. Compressive fixation was applied directly in the case of stable fracture after reduction,while in the case of unstable fracture, the communicated and unstable bone fragments were fixed with 1 to 3 screws and then pieced together to ensure the stability of the bone ends, leaving the periosteum undisturbed. The tissue defects in the middle and proximal parts of the leg were repaired with medial head of gastrocnemius or transferred gastrocnemius musculocutaneous flap, and the defects in the middle and distal parts were covered with neighboring fascial flaps. Results In 94 cases (87.8%) the wound healed at the primary stage. Duration of bone healing was 4.5 to 6.5 months (mean duration being 5 months). Conclusion The method of compressive external fixation is simple and effective for the operative management of the open tibia fracture. It provides stable fixation and least disturbance of blood supply, and thus facilitates fracture healing.