摘要
目的探讨混合式骨外固定治疗胫骨近端复杂骨折的有效性并与切开复位内固定进行比较。方法回顾性分析自2000年1月至2005年1月收治的胫骨近端复杂骨折69例。除术中和术后48h各1例因软组织损伤严重而截肢外,共分析67例。其中关节内复杂骨折40例,根据Schatzker分型标准:Ⅳ型17例,Ⅴ型14例,Ⅵ型9例;关节外复杂骨折27例,根据AO分型标准,均为A3型。19例Ⅱ度以上开放性骨折和21例闭合性骨折采用混合式骨外固定器治疗,其中5例骨折近折段结合有限内固定治疗;2例Ⅰ度开放性骨折和25例闭合性骨折采用切开复位内固定治疗。结果67例患者均获得随访,随访6个月～5年(平均25个月)。骨外固定组,平均手术时间2.66h,平均失血量170.50ml,平均骨折愈合时间16.40周,骨外固定器拆除时间24.67周,术后均无深部感染、皮肤坏死发生,针道感染6例;根据膝关节HSS评分,优31例,良5例,可3例,差1例。切开复位内固定组,平均手术时间3.33h,平均失血量285.19ml,平均骨折愈合时间12.37周,深部感染1例,局部皮肤坏死2例,骨折畸形愈合6例;根据膝关节HSS评分,优5例,良12例,可7例,差3例。两组疗效差异有统计学意义(秩和检验,u=219,P<0.001)。结论混合式骨外固定治疗胫骨近端复杂骨折简便、易行,适应证更广泛,术后膝关节功能恢复较好。
Objective To treat complex fractures of the proximal tibia with the hybrid external fixa- tion and internal fixation and to evaluate their efficiency. Methods During January 2000 to January 2005, 69 patients with complex proximal tibia fractures received operation in our hospital, which included Schatzker types Ⅳ（17 cases）, Ⅴ （14 cases） and Ⅵ（9 cases） and AO A3 type 27 cases, and 2 amputation. The average age was 39 years （range from 18 to 74 years）. Among them, 19 open fractures and 21 closed fractures were operated with hybrid external skeleton fixation （HESF） combined limited internal fixation, the others were treated by open reduction and internal fixation （ORIF）. Results All the patients were followed from 6 months to 5 years（mean, 25 months）, in the HESF group the average time of operation was 2.66 h, the bleeding in operation was 170.50 ml, while ORIF group was 3.33 h and 285.19 ml, the amount healing time of HESF group was 16.40 weeks, while the ORIF groups was 12.37 weeks; there were no deep infectious and skin necrosis patients in the HESF group. According to the HSS score system, there were excellent 31, good 5, fair 3 and bad 1 case, the rate of excellent and good was 90%. In the ORIF group, there were 1 deep infectious and 2 skin necrosis patients, 6 cases were malunion, 2 cases were nonunion. There were excellent 5, good 12, fair 7, bad 3 cases, the rate of excellent and good was 63%; and there were significantly difference between the two groups （u=219, P〈 0.001）. Conclusion It was an easy and effective way to treat the communicated proximal tibia fractures by HESF combined limited internal fixation.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2006年第8期529-534,共6页
Chinese Journal of Orthopaedics
关键词
胫骨骨折
膝关节
外固定器
Tibial fractures
Knee joint
External fixators
作者简介
通信作者：张弢
