混合环形外固定支架治疗老年人胫骨下端开放性骨折

目的胫骨远端骨折为高能量骨折,其治疗极为棘手,尤其对于开放性胫骨远端的治疗尤为困难。我们采用混合环形外固定支架治疗老年人胫骨下端未移位开放性骨折,评价其临床治疗效果及并发症的发生。方法本组共11例,骨折类型为局限于胫骨下端干骺端骨折或累及踝关节但关节面平整者,均采用混合环形外固定支架进行治疗。如患者存在腓骨骨折,则采用常规手术方法1/3管型钢板固定腓骨,之后作环形混合外固定支架进行固定。术后抬高患肢,鼓励做脚趾的活动和踝关节的活动。术后1个月随访复查,术后2两个月进行负重训练。结果11例患者均得到随访,随访时间为12～24个月(平均14.6个月)。开始负重时间为术后6周～12个月(平均3.9个月)。住院时间为14～60d(平均20.5d)。骨折愈合时间为术后4～10个月(平均7.3个月)。所有患者均未出现深部感染,没有骨外露。2例患者出现原伤口感染,经过换药治疗后感染控制,自行愈合。所有患者的踝关节主、被动活动均未受限。拆除外支架时间为术后8～14个月(平均10.5个月)。拆除外支架后没有病例出现再次骨折。结论环形混合外固定支架是治疗胫骨下端未移位开放性骨折的一种较为理想和可靠的方法。

Clinical Application of Hybrid External Fixation in the Treatment of Distal Tibia Fractures

Objective The treatment of distal tibial fractures caused by high energy, are more difficult, especially to open fractures. In this research, we used hybrid external fixation frames to treat un-displacement open fractures of distal tibia of elder people. The clinical therapeutic effect and complication were evaluated. Methods From 2004.1 to 2005.12, 11 patients （3 males, 8 females; age, 65-78 years） with distal tibia fractures underwent the hybrid external fixation. Results The period of follow-up ranged from 12 to 24 months （average 14.6 months）. Weight bearing began at 6 weeks to 12 months postoperatively （average 3.9 months）. The time of hospitalization was 14 to 60 days （average 20.5 days）. The time of bone healing was 4 to 10 months postoperatively （average 7.3 months）. All the patients obtained healing by first intention, apart from 2 patients who had primary wound infection and healed after proper treatment. There was no limitation of initiative or passive motion in ankle joint. The time of pulling out of external fixations was 8 to 14 months postoperatively （average 10.5 months）. After pulling out of external fixations, no tibia fractures occurred. Conclusion Hybrid external fixation is a kind of effective and reliable treatment for un-displacemnet open fractures of distal tibia.