中国伤残医学
中國傷殘醫學
중국상잔의학
CHINESE JOURNAL OF TRAUMA AND DISABILITY MEDICINE
2013年
12期
1-2
,共2页
杨雷刚%刘静%涂忠民%高大龙%董舒%解俊杰%任军龙%赵听%李若飞%刘刚
楊雷剛%劉靜%塗忠民%高大龍%董舒%解俊傑%任軍龍%趙聽%李若飛%劉剛
양뢰강%류정%도충민%고대룡%동서%해준걸%임군룡%조은%리약비%류강
胫骨远端骨折%细针半环外固定架%解剖锁定钢板
脛骨遠耑骨摺%細針半環外固定架%解剖鎖定鋼闆
경골원단골절%세침반배외고정가%해부쇄정강판
Fracture of the distal tibia%Fine-pins semicircle external fixation%Polyaxial locking plating
目的：比较应用细针半环外固定架与解剖锁定钢板治疗胫骨远干骺部短骨折的效果和并发症。方法2：007年1月～2013年4月采用细针半环外固定架和解剖锁定钢板治疗胫骨远干骺部短骨折36例，骨折线距胫骨远端关节面0．5～3．6cm，平均1．2cm，远端骨折涉及冠状面或矢状面方向，有7例GustiloⅠ、Ⅱ型开放性骨折。受伤到固定时间0～14天，平均7．3天。其中细针半环外固定架21例，解剖锁定钢板固定15例，观察伤口愈合及并发症，随访骨折愈合状况，采用Mazur 踝关节功能评分系统进行评估。结果：36例均获随访，时间9～24个月，骨折愈合时间8～13个月，取除内外固定时间5～24个月。细针半环型外固定架随访10．5±3．2个月，针道感染6例，无骨折延迟愈合、骨不连。钢板组随访13．2±2．6个月，皮缘坏死、创口感染3例、钢板外露2例，均经植皮及皮瓣手术后愈合。按照Mazur踝关节功能评分，外固定架组优良率90．5％，锁定钢板组73．3％。结论：细针半环外固定架在治疗短的胫骨远干骺部骨折，尤其是粉碎、开放骨折时，并发症较少，骨折愈合率高，适应证广，应用安全、有效。
目的：比較應用細針半環外固定架與解剖鎖定鋼闆治療脛骨遠榦骺部短骨摺的效果和併髮癥。方法2：007年1月～2013年4月採用細針半環外固定架和解剖鎖定鋼闆治療脛骨遠榦骺部短骨摺36例，骨摺線距脛骨遠耑關節麵0．5～3．6cm，平均1．2cm，遠耑骨摺涉及冠狀麵或矢狀麵方嚮，有7例GustiloⅠ、Ⅱ型開放性骨摺。受傷到固定時間0～14天，平均7．3天。其中細針半環外固定架21例，解剖鎖定鋼闆固定15例，觀察傷口愈閤及併髮癥，隨訪骨摺愈閤狀況，採用Mazur 踝關節功能評分繫統進行評估。結果：36例均穫隨訪，時間9～24箇月，骨摺愈閤時間8～13箇月，取除內外固定時間5～24箇月。細針半環型外固定架隨訪10．5±3．2箇月，針道感染6例，無骨摺延遲愈閤、骨不連。鋼闆組隨訪13．2±2．6箇月，皮緣壞死、創口感染3例、鋼闆外露2例，均經植皮及皮瓣手術後愈閤。按照Mazur踝關節功能評分，外固定架組優良率90．5％，鎖定鋼闆組73．3％。結論：細針半環外固定架在治療短的脛骨遠榦骺部骨摺，尤其是粉碎、開放骨摺時，併髮癥較少，骨摺愈閤率高，適應證廣，應用安全、有效。
목적：비교응용세침반배외고정가여해부쇄정강판치료경골원간후부단골절적효과화병발증。방법2：007년1월～2013년4월채용세침반배외고정가화해부쇄정강판치료경골원간후부단골절36례，골절선거경골원단관절면0．5～3．6cm，평균1．2cm，원단골절섭급관상면혹시상면방향，유7례GustiloⅠ、Ⅱ형개방성골절。수상도고정시간0～14천，평균7．3천。기중세침반배외고정가21례，해부쇄정강판고정15례，관찰상구유합급병발증，수방골절유합상황，채용Mazur 과관절공능평분계통진행평고。결과：36례균획수방，시간9～24개월，골절유합시간8～13개월，취제내외고정시간5～24개월。세침반배형외고정가수방10．5±3．2개월，침도감염6례，무골절연지유합、골불련。강판조수방13．2±2．6개월，피연배사、창구감염3례、강판외로2례，균경식피급피판수술후유합。안조Mazur과관절공능평분，외고정가조우량솔90．5％，쇄정강판조73．3％。결론：세침반배외고정가재치료단적경골원간후부골절，우기시분쇄、개방골절시，병발증교소，골절유합솔고，괄응증엄，응용안전、유효。
Objectiev :To investigate the clinical outcomes of fractures of the distal tibia with very short metaphyseal fragments treated with fine-pins semicircle external fixation and polyaxial locking plating .Methods :From Januray 2007 to April 2013,36 patients with fractures of the distal tibia with very short metaphyseal fragments were randomly divided into 2 groups.21 patients were treated with semi-circle external fixator ,15 patients were treated with a polyaxial locking plate .The average distance from the distal extent of the fracture to the tibial plafond was 12mm (range ;5-36mm),involving coronal and sagittal direction .According to Gustilo classification,there was 5 type I cases and 2 type II cases,All patients were treated within 7.3 days after injury on average (range; 0-14 days).The incision and complications were observed .The patients were followed up until fracture healing .The results were evaluated by Mazur scores .Results:All patients were followed up from 9-24 months.The fracture heeling time was 8-13 months .The external fixator and plating were re-moved from 5 to 24 months after surgery .Patients with the external fixator operation were followed up for 10.5 ±3.2 months .Need tract infection were observed in 6 cases ,there were no case of delayed bone union、nonunion .Patients with the plating operation were followed up for 13.2 ±2.6 months,there were 3 cases of skin sloughs and wound infection ,2 cases of plate exposure , they were threated by flap transfer and dermatonecrosis .According to Mazur evaluation criteria ,the excellent and good rate with the external fixator was 90.5%and with the plate was 73.3%.Conclusion:Fine-pins semicircle external fixation might be a safe and effective technique for treating of frac -tures of the distal tibia with very short ,the advantages of less invasion 、low infection and higher union rate、steady fixation for treating of the open and comminuted fractures .
