摘要
目的探讨GustiloⅢA型胫骨开放性骨折的治疗方法及临床疗效。方法对2008年1月～2011年1月我院收治并获得随访资料的55例GustiloⅢA型胫骨开放性骨折进行回顾性分析,其中A组27例采用清创,Ⅰ期应用非扩髓带锁髓内钉或锁定接骨板内固定,伤口深部置管冲洗,创面用负压封闭引流(VSD)材料封闭,持续负压引流的方法进行治疗;B组28例采用清创+外固定支架固定的常规方法进行治疗,记录两组病例的术后感染、固定失败、骨折延迟愈合及不愈合发生率,并按照Johner-Wruhs评定标准进行患肢功能评价。结果所有患者术后获得6～36个月(平均18个月)的随访,患肢功能评定A组优良率88.9%,B组优良率64.3%,差异有统计学意义(P<0.05);A组感染率7.4%、B组感染率7.1%,A组固定失败率3.7%、B组固定失败率17.8%,感染率及固定失败率比较差异无统计学意义(P>0.05);A组骨折延迟愈合发生率14.8%,B组骨折延迟愈合发生率39.3%,差异有统计学意义(P<0.05)。结论在严格清创结合置管冲洗和VSD的前提下,GustiloⅢA型胫骨开放性骨折采用Ⅰ期内固定方式治疗可以获得满意疗效。
Objective To investigate the method and clinical effect of open tibial fractures of Gustilo grade- ⅢA. Methods The data of 55 patients with open tibial fractures who were treated from Jan. 2008 to Jan. 2011 in our hospital were retrospectively analyzed. Of them,27 patients（group A）were treated with internal fixation（primary internal fixation group}. After the debridement, fractures were fixed by unreamed interlocking intramedullary nail or locking plate. Drainage tube was placed for irrigation, and then the wound area was covered with the VSD system. While 28 patients （ group B ） received traditional treatment with unilateral external fixator after the debridement （ external fixator group ）. A retrospective comparison was made between the patients treated with the two different fixation devices in terms of infection, fixation failure and delayed union or nonunion. The clinical outcome was evaluated by Johner-Wrnhs assessment criteria. Results The patients were followed up for 6 to 36 months （ mean, 18 months）. The total excellent to good rate for functional recovery was 88.9% for group A and 64.3 % for group B. The infection rate was 7.4% for group A and 7.1% for group B. The incidence rate of fixation failure was 3.7% for group A and 17.8 % for group B. The bone delayed union developed in 14.8% of the patients for group A and 39.3% for group B. There was significant difference between the groups in the excellent to good rates and rates of delayed union. Conclusion Under condition of good irrigation and vacuum sealing drainage following the debridement,the way of primary internal fixation could achieve good outcomes in the treatment of open tibial fractures of Gustilo grade- Ⅲ A.
出处
《创伤外科杂志》
2012年第1期48-52,共5页
Journal of Traumatic Surgery
关键词
胫骨骨折
固定术
负压封闭引流
tibial fractures
fixation
vacuum sealing drainage
