摘要
目的:回顾性分析开放性浮膝损伤的治疗及功能疗效以探讨合理的治疗方法。方法:手术治疗41例开放性浮膝损伤,男29例,女12例;年龄17～64岁,平均34岁。骨折分类:双干型15例,双髁型8例,混合型18例;骨干部用髓内钉,髁部用钢板。55处开放伤按Gustilo分类:Ⅰ型8处、Ⅱ型18处、Ⅲ型29处(ⅢA型15处、ⅢB型9处、ⅢC型5处)。早期清创后分别采用:Ⅰ期缝合、减张缝合、植皮、带蒂肌瓣转位加植皮、肌皮瓣转位等闭合伤口。结果:截肢8例,余33例随访12～36个月,平均21.5个月。7例骨延迟愈合或不愈合,6例轻度畸形愈合,5例伸膝位僵硬。骨愈合时间:胫骨3～18.5个月,平均6.5个月;股骨3～15个月,平均5个月。疗效按Karlstrom和Olerud标准评价:优9例,良16例,可7例,差1例。结论:早期彻底清创,妥善固定骨折,个性化地修复软组织损伤,及早锻炼,是提高疗效的关键。
Objective：To explore the difficulties and treatment for open floating knee injuries. Methods：Forty-one patients with open floating knee injuries were treated by operation including 29 males and 12 females with an average age of 34 years ranging from 17 to 64 years. The patients were divided into 3 types：the diaphyseal fracture type in 15 cases,the condylar fracture type in 8 cases and the diaphyseal-condylar mixed type in 18 cases. Fixation in the diaphyseal fracture was intramedullary, in the condylar fracture was plate. Open wound of 55 parts was according to Gustilo classification,8 in grade Ⅰ , 18 in grade Ⅱ ,29 in grade Ⅲ （included Ⅲ A in 15, Ⅲ B in 9, Ⅲ C in 5 ）. After debrided thoroughly according to injury classification, the soft tissue were repaired with primary suture, a split skin-graft, cutaneous flaps, muscle flaps or muscular cutaneous flaps. Results：Primary amputation was procedured in 8 patients. The others treated by bone fixation were followed-up for 12 to 36 months with an average 21.5 months. Local complications included 5 deep infection,7 delay union or non-union,6 deformity and 5 knee joint ankylosis. The healing times of the tibia ranged in from 3 to 18. 5 months at an average 6.5 months,the femur ranged in from 3 to 15 months at an average 5 months. The efficacy of treatment was scored by Karlstrom and Olerud＇s criteria, functional evaluation showed that 9 cases had an excellent result, 16 good,7 fair and 1 poor. Conclusion： Early debridement thoroughly, satisfactory bone fixation, reconstruction for soft tissue individually and early mobilization of the knee are tile key to increases the effects of management for open floating knee injuries.
出处
《中国骨伤》
CAS
2007年第11期744-745,共2页
China Journal of Orthopaedics and Traumatology
关键词
浮膝损伤
骨折
骨折固定术
内
Floating knee injury
Fractures
Fracture fixation,internal
