摘要
目的:探讨组合式外固定支架治疗复杂胫骨干骺端骨折的疗效。方法:自2007年1月至2012年7月采用组合式外固定支架分期治疗34例复杂胫骨干骺端骨折,其中男23例,女11例;年龄16~63岁,平均41.3岁;病程1 h^8 d。31例为开放性骨折,采用Gustilo分型:Ⅱ型11例,ⅢA型13例,ⅢB型7例。胫骨平台骨折19例,采用Schatzker分型:Ⅱ型6例,Ⅳ型1例,Ⅴ型5例,Ⅵ型7例。胫骨远端骨折15例(其中1例患者为双侧),按AO分型:A2型2侧,A3型1侧,C1型1侧,C2型5侧,C3型7侧。分别采用Rasmussen和AOFAS踝-后足评分系统对患者膝、踝关节功能进行评定。结果:创面获得Ⅰ期愈合19例,Ⅱ期愈合15例。发生浅表伤口感染2例,骨不连2例(再手术后获得骨愈合)。34例患者均获随访,时间6~38个月,平均14.3个月。末次随访时,Rasmussen评分为23.58±3.98,优5例,良11例,可3例;AOFAS踝-后足评分为80.75±14.21,优5例,良8例,可3例。结论:组合式外固定支架用于治疗复杂胫骨干骺端骨折,能有效维持骨断端的稳定性,组织感染坏死率低,对关节活动影响小,但长期使用有一定局限性。
Objective： To observe the clinical effects of combined type external fixator in treating complex tibial metaphy- seal fractures. Methods：From January 2007 to July 2012,34 patients with complex tibial metaphyseal fractures were treated with combined type external fixator in different stagings. There were 23 males and 11 females,with a mean age of 41.3 years （ranged, 16 to 63 ）, and the course of disease were from 1 h to 8 d. In the patients, 31 cases were open fractures, 11 cases with type Ⅰ , 13 cases with type Ⅲ A, 7 cases with type Ⅲ B according with Gustilo classification ; 19 cases were tibia plateau frac- tures, 6 cases with type Ⅱ, 1 case with type Ⅳ, 5 cases with type V, 7 cases with typeⅥaccording to Schatzker classification; 15 cases were distal tibial fractures （one were bilateral fractures）, 2 fractures with type A2,1 fracture with type A3,1 fracture with type C1,5 fractures with type C2,7 fractures with type C3 according to AO classification. Rasmussensn scoring system and AOFAS Ankle Hind-foot Scale were respectively used to assess the joint function of knee and hip. Results： Wound surface of 19 patients obtained at phase I healing and 15 patients obtained at phase I1 healing. Superficial wound infections occurred in 2 cases and bone non-union necessitated reoperation occurred in 2 cases （final fractures obtained bone healing after the second operation）. All patients were followed up from 6 to 38 months with a mean of 14.3 months. At the final follow-up,ac- cording to Rasmussensn scoring system, 5 fractures got excellent results, 11 good, 3 fair, the mean Rasmussen score was 23.58± 3.98 ;according to AOFAS Ankle Hind-foot Scale, 5 fractures got excellent results, 8 good, 3 fair, the mean AOFAS Ankle Hind -foot Scale was 80.75±14.21. Conclusion：Combined type external fixator can well maintain the stability of the fractures, had advantages of low incidences of soft tissue complications and less influence to joint motion in treatment of complicated tibial metaphyseal fractures, However there were some limitations in long-term use.
出处
《中国骨伤》
CAS
2014年第5期425-429,共5页
China Journal of Orthopaedics and Traumatology
关键词
胫骨
干骺端
骨折
外固定器
Tibia
Metaphysis
Fractures
External fixators
作者简介
通讯作者：张财义E—mail：zhangcaiyi@126．com.
