CAJ | 학술논문

背景：胫腓骨开放性骨折是四肢长骨中最易出现的骨折，单纯外固定常难以实现彻底有效的复位和固定，而切开复位内固定的缺点突出表现在术后并发症高发，严重影响关节功能的恢复，因此将外固定与内固定方法相结合修复胫腓骨开放性骨折目前在临床上应用比较多。 　　目的：探讨胫腓骨中下段开放性骨折采用双臂外固定架结合有限切开内固定的修复效果。 　　方法：回顾性分析济宁市第一人民医院2009年1月至2013年1月收治的56例经X射线检查或CT影像学检查确诊为胫腓骨中下段开放性骨折患者的临床资料，作为治疗组，患者均在入院8 h内进行彻底清创、复位骨折断端并进行有限内固定、固定双臂外固定架及Ⅰ期缝合，待损伤局部条件允许行Ⅱ期植皮、邻近肌皮瓣或游离皮瓣闭合修复创面。观察其修复效果及术后并发症发生情况，并与44例同期行单纯切开复位内固定修复胫腓骨中下段开放性骨折的患者(对照组)进行对比。 　　结果与结论：治疗组56例患者中，疗效优35例，良16例，可4例，差1例，优良率为91%；对照组44例患者中，疗效优23例，良10例，可7例，差4例，优良率为75%，治疗组优良率显著高于对照组(P <0.05)。两组患者在手术切口长度、手术时间、骨折愈合时间、骨不连发生率方面差异均有显著性意义，治疗组均优于对照组(P <0.05)。提示采用双臂外固定架结合有限切开内固定修复胫腓骨中下段开放性骨折断端固定可靠，可显著降低单纯内固定引起的术后并发症，促进骨折愈合，有利于患肢及早进行恢复性训练。
배경：경비골개방성골절시사지장골중최역출현적골절，단순외고정상난이실현철저유효적복위화고정，이절개복위내고정적결점돌출표현재술후병발증고발，엄중영향관절공능적회복，인차장외고정여내고정방법상결합수복경비골개방성골절목전재림상상응용비교다。 　　목적：탐토경비골중하단개방성골절채용쌍비외고정가결합유한절개내고정적수복효과。 　　방법：회고성분석제저시제일인민의원2009년1월지2013년1월수치적56례경X사선검사혹CT영상학검사학진위경비골중하단개방성골절환자적림상자료，작위치료조，환자균재입원8 h내진행철저청창、복위골절단단병진행유한내고정、고정쌍비외고정가급Ⅰ기봉합，대손상국부조건윤허행Ⅱ기식피、린근기피판혹유리피판폐합수복창면。관찰기수복효과급술후병발증발생정황，병여44례동기행단순절개복위내고정수복경비골중하단개방성골절적환자(대조조)진행대비。 　　결과여결론：치료조56례환자중，료효우35례，량16례，가4례，차1례，우량솔위91%；대조조44례환자중，료효우23례，량10례，가7례，차4례，우량솔위75%，치료조우량솔현저고우대조조(P <0.05)。량조환자재수술절구장도、수술시간、골절유합시간、골불련발생솔방면차이균유현저성의의，치료조균우우대조조(P <0.05)。제시채용쌍비외고정가결합유한절개내고정수복경비골중하단개방성골절단단고정가고，가현저강저단순내고정인기적술후병발증，촉진골절유합，유리우환지급조진행회복성훈련。
BACKGROUND:Open fracture of tibia and fibula is a common fracture of long bones. Simple external fixation is often difficult to achieve thorough and effective reduction and fixation. Shortcomings of open reduction and internal fixation highlighted in the high incidence of postoperative complications, and seriously affected the recovery of joint function. Therefore, external fixation combined with internal fixation for repair of open fractures of tibia and fibula has been extensively used in the clinic. OBJECTIVE:To explore the repair efficacy of bilateral external fixation combined with limited internal fixation on open fractures of middle and distal tibia and fibula. METHODS: Clinical data of 56 patients, who were identified by X-ray or CT examination and were diagnosed as having open fractures of middle and distal tibia and fibula in the Jining No.1 People’s Hospital, as the treatment group, were retrospectively analyzed from January 2009 to January 2013. Patients were subjected to thorough debridement, reduction of the fracture fragments, limited internal fixation and fixed bilateral external fixation within 8 hours. They received stage I suture. When the local conditions of the wound permitted, they received stage II grafting, and were repaired with adjacent muscle flap or free flap. The efficacy and postoperative complication were observed. Above data were compared with those of 44 patients with open fractures of middle and distal tibia and fibula who received reduction and internal fixation (control group). RESULTS AND CONCLUSION:Among the 56 patients in the treatment group, the outcomes were excelent in 35 cases, good in 16 cases, average in 4 cases and poor in 1 case. The excelent and good rate was 91%. Among the 44 patients in the control group, the outcomes were excelent in 23 cases, good in 10 cases, average in 7 cases and poor in 4 cases. The excelent and good rate was 75%. The excelent and good rate was significantly higher in the treatment group than that of the control group (P < 0.05). Significant differences in incision length, operation time, fracture healing time and bone nonunion rate were detected between the two groups, and above indexes were better in the treatment group than in the control group (P < 0.05). These findings verify that bilateral external fixation combined with limited internal fixation for open fractures of middle and distal tibia and fibula is reliable, can significantly reduce postoperative complications after internal fixation, promote the healing of fracture, and is conducive to the early recovery training of the affected limb.