外固定架在地震致重度胫腓骨开放性骨折早期处理中的应用

目的 评估外固定架应用于地震伤致重度胫腓骨开放性骨折的早期治疗效果.方法 2008年5月12至17日收治83例(116侧)地震伤致胫腓骨开放性骨折伤员(均为Gustilo Ⅲ度开放性骨折),均采用积极清创结合外固定架治疗,主要评估指标包括深部感染的发生、截肢及伤口愈合情况.结果 83例(116侧骨折)伤员获18-23d随访.9侧Ⅲc型骨折术后出现肢体缺血坏死而行截肢术,1侧Ⅲb型骨折因肢体感染坏死合并脓毒败血症而行截肢术.20侧肢体出现深部感染,经反复创口清创、扩创后感染得到控制.伤口一期愈合52侧,二期愈合54侧(包括使用皮瓣、肌瓣、肌皮瓣转移及植皮术等治疗).结论 地震伤致重度胫腓骨开放性骨折的早期治疗中,应用外固定架固定可作为一种有效的治疗手段.

External fixation in early treatment of severe open tibiofibular fractures following earthquake

Objective To evaluate the external fixators used in early treatment of severe open tibiofibular fractures following the "5.12" earthquake in Sichuan, China. Methods From 12th to 17th of May, 2008, we admitted a total of 116 open tibiofibular fractures of grade Ⅲ in 83 patients who were injured in the Sichuan earthquake catastrophe. They were treated by radical debridement combined with external fixation. Early effects of our treatment were analyzed in terms of incidence of deep infection, amputation and wound healing. Results The short term observation showed that the overall infection rate for all grade Ⅲ open tibiofibular fractures was 17.2% (20 factures). Amputation of limbs was done for 9 fractures of grade Ⅲ C due to ischemic necrosis and 1 fracture of grade III b due to infective necrosis complicated with septicopyemia. The total amputation rate was 8.62%. Twenty injured limbs had deep infections which were controlled by repeated debridement and curettage. Union rate was 100% among all the saved limbs, although some cases required free tissue transfer or rotational muscle flap coverage. Wounds healed by first intention in 52 cases and by second intension in 54 cases. Conclusion In the early treatment of severe open tibiofibular fractures following an earthquake, external fixation may be a useful instrumentation.