截肢与保肢术治疗严重胫骨开放性骨折的病例对照研究

目的：比较Ⅰ期截肢和保肢手术治疗胫骨GustiloⅢB,ⅢC型开放性骨折患者的中期临床疗效.方法：自2007年7月至2010年6月,对分别采用截肢与保肢治疗的68例单侧胫骨GustiloⅢB,ⅢC型开放性骨折患者的临床资料进行回顾性分析.截肢组38例,男26例,女12例;平均年龄（44.9±16.3）岁;GustiloⅢB型21例,ⅢC型17例,根据小腿皮肤软组织损伤程度、骨折类型、位置和手术探查所见选择截肢平面.保肢组30例,男21例,女9例;平均年龄（43.5±14.7）岁;GustiloⅢB型23例,ⅢC型7例,根据患者具体情况选择骨折固定方式及创面修复方法.比较两组患者的手术时间、失血量、住院时间及术后感染率;比较两组患者术后平均负重时间及重返原工作率;采用痛觉模拟评分（VAS）评估患者的疼痛情况;并采用SF-36健康量表评估患者术后的生活质量.结果：共60例患者（截肢组33例,保肢组27例）获得随访,平均随访时间49.1个月.截肢组、保肢组的手术时间、失血量、住院时间及术后感染率分别为：（109.0±25.7）min,（245.0±58.6）min;（168.0±49.0）ml,（311.0±137.0）ml;（13.8±2.7） d,（28.8±13.1） d;7.9％,36.7％.至末次随访时,两组患者的VAS评分及重返原工作率比较差异无统计学意义,但截肢组术后平均负重时间更短.截肢组患者的生理机能评分优于保肢组,而保肢组患者的躯体疼痛评分优于截肢组,两组患者的心理健康比较差异无统计学意义.结论：Ⅰ期截肢与保肢手术均为治疗严重小腿开放性骨折的重要手段,两者中期临床疗效相当.

Case-control study on treating severe tibial open fractures by amputation and limb salvage

Objective：To compare mid-term clinical outcomes between amputation and limb salvage in treating severe open tibial fractures with type Gustilo Ⅲ B,Ⅲ C.Methods：From July 2007 to June 2010,68 patients with severe open tibial fractures with type Gustilo Ⅲ B,Ⅲ C treated by amputation and limb salvage were retrospectively analyzed.In amputation group,there were 26 males and 12 females with an average age of （44.9± 16.3） years old;and 21 cases were type Gustilo Ⅲ B,17 cases were Gustilo ⅢC ; amputation were performed in accordance with soft tissue injury degree of shank,fracture types and surgical exploration.In limb salvageg group,there were 21 males and 9 females with an average age of （43.5± 14.7） years old; and 23 cases were type Gustilo Ⅲ B,7 cases were Gustilo Ⅲ C; the method of internal fixation and and wound healing were performed in accordance with patients＇s specific condition.Operative time,blood loss,hospital stay and postoperative infection was compared between two groups; time of loading and rate of return to work was compared ; VAS scoring was used to evaluate condition of pain; SF-36 health queationaire was used to assess postoperative life quality.Results：Totally 60 patients were followed up （33 cases in amputation group and 27 cases in limb salvage group） with an average time of 49.1 months.Operative time,blood loss,hospital stay and postoperative infection in amputation and limb salvage group respectively was （109.0±25.7） min,（245.0±58.6） min; （168.0±49.0） ml,（311.0±137.0） ml; （13.8±2.7） d,（28.8±13.1） d;7.9％,36.7％.At the final following-up,there was no significance meaning between two groups in VAS scoring and rate of return to work,but time of loading in amputation group was shorter than that of in limb salvage group.Physiological function in amputation group was better than limb salvage group,while body pain was worse ;and there was no signicance meaning in psychological health between two groups.Conclusion：Amputation and lim