摘要
目的观察自制的双边三角形万向可伸缩外固定支架治疗开放性关节内粉碎性跟骨骨折的效果。方法对2011年1月至2014年6月收治并获得随访的12例开放性关节内粉碎性跟骨骨折患者资料进行回顾性分析，男8例，女4例；年龄23—58岁，平均36．8岁；骨折按照Sanders分型：Ⅱ型4例，Ⅲ型7例，Ⅳ型1例；软组织损伤按照Gustilo分型：Ⅱ型2例，ⅢA型7例，ⅢB型3例。所有患者急诊行伤口清创，根据伤口软组织损伤情况一期行闭合伤口或负压封闭引流覆盖，根据病情7例急诊、5例在伤后3。5d行自制的双边三角形万向可伸缩外固定支架撑开克氏针撬拨，克氏针或空心钉固定。待确定创口无明显感染后，6例择期行外侧切口切开复位内固定，6例一直使用外固定支架及辅助克氏针固定8—10周（平均9．1周）。结果12例患者术后获6—36个月（平均18．5个月）随访，美国足踝外科协会的踝．后足评分平均为84．6分（74—94分），有1例患者后期行游离植皮覆盖伤口，有3例患者发生伤口浅表感染，无深部感染及需要截肢治疗患者，6例患者二期行切开复位内固定者无一例发生切口感染及坏死。结论开放性跟骨骨折应用自制的双边三角形万向可伸缩外固定支架支撑辅助固定，把握内固定的时机和手术指征、选择恰当的固定方法可以有效降低术后深部感染和骨髓炎的发生率。
Objective To report the clinical outcomes of the patients with open comminuted in- tra-articular calcaneal fracture who were treated with our self-designed bilateral triangle external fixators which are extensible and gimbaled. Methods Between January 2011 and June 2014, 12 patients with open cornminuted intra-articular caleaneal fracture were treated and followed up. They were 8 men and 4 women, aged from 23 to 58 years （average, 36.8 years）. According to the Sanders classification, the fractures were type Ⅱ in 4 eases, type Ⅲin 7, and type 1V in one. According to the Gustilo classification, the soft tissue injury was type Ⅱin 2 cases, type Ⅲ A in 7, and type Ⅲ B in 3. All the patients were treated with immediate debridement and preventive intravenous antibiotics. First stage wound closure or temporary coverage with vacuum sealed drainage was chosen according to the condition of soft tissue injury. Our self-designed bilateral triangle external fixators were applied together with cannulated screws or Kirschner wire in all the patients after Kirschner wire poking. Of them, 7 received emergency treatment and 5 were treated 3 to 5 days after injury. After no wound infection was observed for sure, 6 cases received selective open reduction and internal fixation via a lateral incision while 6 continued external fixation with Kirschner wire for 8 to 10 weeks （average, 9. 1 weeks） . Results The 12 patients were followed up for 6 to 36 months （average, 18.5 months）. Their AOFAS scores averaged 84.6 points （range, from 74 to 94 points） . One case required tissue transfer for wound coverage. Wound shallow infection developed in 3 cases. No deep infection or amputation happened. No wound infection or necrosis occurred in the 6 cases that had undergone open reduction and internal fixation at the second stage. Conclusion Application of our self-designed extensible gimbaled bilateral triangle external fixators in the treatment of open comminuted intra-articular calcaneal fractures may help effectively reduce the deep infection or incidence of os- teomyelitis after operation as long as early debridement is thorough, internal fixation is timely applied, and in- dications for internal fixation are properly followed.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2016年第9期809-813,共5页
Chinese Journal of Orthopaedic Trauma
基金
中国专利号：ZL201120169378.6基金项目：浙江省医药卫生科技项目（2010KYA190）
关键词
跟骨
骨折
开放性
外固定器
并发症
Calcaneus
Fractures, open
External fixator
Complications
