CAJ | 학술논문

目的：探讨早期清创有限内固定结合分期手术治疗胫腓骨开放性骨折的疗效。方法2011年1月～2013年12月，采用早期清创有限内固定结合分期手术治疗40例高能量胫腓骨开放性骨折。男28例，女12例，年龄16～72岁，平均35．6岁。开放性损伤按 Gustilo 分型，Ⅱ型16例，ⅢA 型20例，ⅢB 型4例。均行急诊清创、骨折复位、有限内固定，依据具体情况采用直接缝合或负压封闭引流（vaceum sealing drainage，VSD）技术暂时封闭创面，二期修复软组织创面，并采用微创钢板内固定（MIPPO）技术或外固定支架固定骨折。结果40例术后随访12～36个月，平均18个月。39例骨折愈合，愈合时间6～22个月，平均12．2月。1例骨不连，拆除外固定支架二期植骨钢板螺钉内固定，最终骨折愈合。20例二期行游离植皮，5例行局部带蒂皮瓣转移。末次随访时按照 Johner-Wruhs 评分标准评定膝、踝关节功能，优28例，良10例，差2例，优良率95％（38／40）。结论早期清创有限内固定结合分期手术治疗高能量胫腓骨开放性骨折，能有效维持骨折端相对稳定，方便软组织损伤修复及骨折二期处理，是一种安全、有效的治疗方法。
목적：탐토조기청창유한내고정결합분기수술치료경비골개방성골절적료효。방법2011년1월～2013년12월，채용조기청창유한내고정결합분기수술치료40례고능량경비골개방성골절。남28례，녀12례，년령16～72세，평균35．6세。개방성손상안 Gustilo 분형，Ⅱ형16례，ⅢA 형20례，ⅢB 형4례。균행급진청창、골절복위、유한내고정，의거구체정황채용직접봉합혹부압봉폐인류（vaceum sealing drainage，VSD）기술잠시봉폐창면，이기수복연조직창면，병채용미창강판내고정（MIPPO）기술혹외고정지가고정골절。결과40례술후수방12～36개월，평균18개월。39례골절유합，유합시간6～22개월，평균12．2월。1례골불련，탁제외고정지가이기식골강판라정내고정，최종골절유합。20례이기행유리식피，5례행국부대체피판전이。말차수방시안조 Johner-Wruhs 평분표준평정슬、과관절공능，우28례，량10례，차2례，우량솔95％（38／40）。결론조기청창유한내고정결합분기수술치료고능량경비골개방성골절，능유효유지골절단상대은정，방편연조직손상수복급골절이기처리，시일충안전、유효적치료방법。
Objective To explore the clinical effects of emergency debridement and simple internal fixation combined with two-staged strategies for treating patients with open tibiofibular fractures. Methods From January 201 1 to December 2013,40 patients with open fracture of tibia and fibula were treated in our department.They were 28 males and 12 females,aged from 16 to 72 years old (mean,35.6 years old).By the Gustilo classification,there were 16 cases of typeⅡ,20 cases of type ⅢA and 4 cases of type ⅢB.All the fractures were treated with emergency debridement and simple internal fixation.The wounds were sealed with vaceum sealing drainage(VSD)or direct suture during the first stage,and then were repaired at the secondary stage.The fractures were treated with minimally invasive percutaneous plate osteosynthesis(MIPPO)or external fixation. Results All the patients were followed up for 12 to 36 months (mean,18 months).Bone union was obtained in 39 fractures after an average time of 12.2 months (range,6 -22 months).One patient with nonunion was given external fixator removal and iliac bone graft with plate fixation until fracture union. Secondary free skin grafting was performed in 20 patients,and pedicled skin flap transposition was performed in 5 patients.According to the Johner-Wruhs criteria for functional recovery of the knee and ankle at the last follow-up,28 cases were graded as excellent,10 as good and 2 as poor,giving a good to excellent rate of 95% (38 /40). Conclusion Emergency debridement and simple internal fixation combined with two-staged strategies is a safe and effective treatment for open fracture of tibia and fibula,because it can provide not only effective fixation but also convenient repair of soft tissue and staged reconstruction of bone.