复杂性胫腓骨骨折137例

目的 探讨复杂性胫腓骨骨折治疗中骨折与软组织损伤处理的方法。方法 对１３７例复杂性胫腓骨骨折的治疗进行分析。其中胫腓骨多段骨折８９例，伴有软组织缺损的胫腓骨开放粉碎骨折２７例，合并血管神经损伤的胫腓骨骨折２１例，有１１８例获得１０个月￣５年２个月的随访，平均随访２年３个月。

Treatment of 137 cases of complex tibial and fibular fractures

Objective To find the optimal scheme on the basis of analysis of the treatment of complex tibial and fibular fractures. Methods We analyzed retrospectively 137 cases of complex tibial and fibular fractures. Among them, 89 cases had multi-segment fractures of the tibia and fibula, 27 complicated with soft tissue defect, and 21 complicated with vessel and nerve injury. Follow-up was conducted on 118 patients for 10 months to 5 years and 2 months with 2 years and 3 months on average. Results Ender's nail showed a minimum occurring rate of delay-union of the fractures in the treatments of multi-segment fractures of the tibia and fibula. Closing the wound in the first stage and performing decompression incision had the least rate of skin necrosis and infection. For cases combining soft tissue defect, the treatment with external fixator exhibited the least occurring rate of delay-union. Repair of soft tissue defect by regional pedicular myocutaneous flap or cross-leg myocutaneous flap had the highest survival rate. No necrosis of extremities was found in cases of vessel and nerve injuries. Seven out of the 118 cases had dysfunction of the knee joint. Conclusions Any option of the treatments should not aggravate the injury to soft tissue. Ender's nail and external fixator are the first choice in the treatment of the fractures. Pedicular myocutaneous flap and cross-leg myocutaneous flap are optional to repair the soft tissue defect. It is advisable to close the wound in the first stage and performing decompression incision.