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骨科损伤控制理念指导下应用克氏针结合外固定支架治疗胫腓骨远端开放性骨折

Kirschner wire combined with external flxator for open comminuted distal tibiofibular fractures according to the concept of damage control orthopaedics
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摘要 目的结合骨科损伤控制(DCO)理念,应用克氏针结合外固定支架治疗胫腓骨远端开放性粉碎性骨折的疗效。方法回顾性分析2015年1月至2018年8月武警后勤学院附属医院骨科应用克氏针结合外固定支架治疗15例胫腓骨远端开放性粉碎性骨折的患者资料,男12例,女3例;年龄27~62岁,平均46.5岁。骨折Gustilo分型:Ⅰ型1例;Ⅱ型4例;ⅢA型7例,ⅢB型2例,ⅢC型1例。所有患者给予急诊彻底清创、胫骨外固定支架固定,腓骨克氏针内固定,创面应用负压封闭引流(VSD)膜覆盖,术后给予抗炎等综合治疗。出院后定期随访,观察骨折愈合时间、有无延迟愈合、骨髓炎或骨不连等。末次随访时患肢按照美国矫形外科足踝协会(AOFAS)踝.后足评分系统进行评分。结果15例患者术后均获随访,随访时间12~18个月,平均12.8个月。骨折一期愈合13例(86.7%),延迟愈合1例(6.7%),骨不连1例(6.6%),无骨髓炎并发症。末次随访时患肢功能按照AOFAS踝-后足评分:优9例,良4例,中1例,差1例。结论对胫腓骨远端开放性粉碎性骨折的患者,应用DCO理论指导手术治疗,强调早期彻底清创及应用VSD覆盖创面,外固定支架固定胫骨,克氏针内固定腓骨,经济成本低,疗效满意。 Objective To report the clinical efficacy of Kirschner wire combined with external fixator in the treatment of open comminuted distal tibiofibular fractures according to the concept of damage control orthopaedics. Methods A case series study was done on the clinical data of 15 open eomminuted distal tibiofibular fractures which had been treated with kirschner wire combined with external fixation from January 2015 to August 2018 at Department of Orthopedics, Affiliated Hospital to Logistics College of Chinese People's Armed Police. They were 12 men and 3 women, aged from 27 to 62 years (mean, 46.5 years) . By the Gustilo classification, there were one case of type Ⅰ, 4 cases of type Ⅱ, 7 cases of type mA, 2 cases of type ⅢB and one case of type ⅢC. All the patients were treated with emergency debridement, tibial fixation using external fixator and fibular fixation using kirschner wire, followed by vacuum sealing drainage (VSD). Effective anti-inflammatory and other comprehensive treatments were given postoperatively. Regular follow-up was conducted to observe fracture healing and complications like osteomyelitis and bone disconnection. At the final follow-up, the American Orthopaedic Foot Ankle Society (AOFAS) ankle-hindfoot scale was used to evaluate the ankle function. Results All the patients were followed up for 12 to 18 months (mean, 12. 8 months). Primary bone union was achieved in 13 cases (86.7%), delayed healing observed in one case (6. 7% ) and bone nonunion in one case (6. 7% ) . No osteomyelitis occurred. By the AOFAS ankle-hindfoot scale, the ankle function was rated as excellent in 9 cases, as good in 4, as fair in one and as poor in one. Conclusious For patients with open comminuted distal tibiofibular fracture, treatment should be conducted according to the concept of damage control orthopaedics. After early thorough debridement, the tibia should be fixated using external fixator and the fibula using kirschner wire, followed by VSD, leading to economical cost a
作者 孙东东 刘群 孙明林 Sun Dongdong, Liu Qun, Sun Minglin (Department of Orthopaedics, Affiliated Hospital to Logistics College of Chinese People' s Armed Police, Tianjin 300162, China)
出处 《中华创伤骨科杂志》 CSCD 北大核心 2018年第9期768-773,共6页 Chinese Journal of Orthopaedic Trauma
关键词 胫骨骨折 腓骨骨折 外固定器 骨针 损伤控制 Tibial fractures Fibular fractures External fixators Bone nail Damage control orthopaedics
作者简介 通信作者:孙明林,Email:ddssyd@126.com
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