有限内固定结合外固定支架在地震伤员膝关节周围开放性骨折早期治疗中的应用
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摘要
目的:探讨有限内固定结合外固定支架在地震伤员膝关节周围开放性骨折早期治疗中的应用。方法:对汶川大地震中25例膝关节周围开放性骨折早期采用有限切开复位有限内固定,同时结合外固定支架治疗,其中胫骨平台骨折13例,(SchatzkerⅤ型4例,SchatzkerⅥ型9例),股骨远端骨折12例,(AO分型C1型3例,C2型5例,C3型4例),25例开放性骨折按Gustilo分型:GustiloⅡ型5例,GustiloⅢA型8例,GustiloⅢB型10例,GustiloⅢC型2例。结果:术后至患者转院治疗期间两周内,25例开放性伤口均闭合,8例伤口术后出现表浅感染,经加强局部换药感染控制,无伤口深部感染。术后复查X线片无关节面塌陷,骨折无成角畸形,患者出院时无外固定支架钉道松动。结论:有限内固定结合外固定支架为不适宜做内固定治疗的膝关节周围严重开放性骨折提供了一种有效的治疗方法,特别是对于地震等重大灾害所造成的复杂伤情不失为一种较理想的方法。
Objective: To analyze the application of limited internal fixation combined with external fixator for open fractures around the knee in the early stage for erathquke casualty.Methods: Twenty-five cases of open fractures around the knee were trerted by limited internal fixation combined with external fixator early in Wenchuan earthquake,including 13 cases of tibia plateau fractures(SchatzkerⅤ 4 cases,SchatzkerⅥ 9 cases),12 cases of distal femur fractures(AO:33-C1 3 cases,33-C2 5 cases,33-C3 4 cases).All of them are open fractures: GustiloⅡ 5 cases,GustiloⅢA 8 cases,GustiloⅢB 10 cases,GustiloⅢC 2 cases.Results: The open fractures are closed within two weeks after operation before transferred.Superficial infection appeared in 8 cases and were healed changing dressings,no deep infecton appeared.No articular surface collapsed,No angulation deformity appeared,no external fixator loosed by the valuation of radiograph.Conclusion: limited internal fixation combined with external fixator is an ideal methord for open fractures which is not suitable for internal fixation especial for the wounds in nature disasters.
Objective: To analyze the application of limited internal fixation combined with external fixator for open fractures around the knee in the early stage for erathquke casualty.Methods: Twenty-five cases of open fractures around the knee were trerted by limited internal fixation combined with external fixator early in Wenchuan earthquake,including 13 cases of tibia plateau fractures(SchatzkerⅤ 4 cases,SchatzkerⅥ 9 cases),12 cases of distal femur fractures(AO:33-C1 3 cases,33-C2 5 cases,33-C3 4 cases).All of them are open fractures: GustiloⅡ 5 cases,GustiloⅢA 8 cases,GustiloⅢB 10 cases,GustiloⅢC 2 cases.Results: The open fractures are closed within two weeks after operation before transferred.Superficial infection appeared in 8 cases and were healed changing dressings,no deep infecton appeared.No articular surface collapsed,No angulation deformity appeared,no external fixator loosed by the valuation of radiograph.Conclusion: limited internal fixation combined with external fixator is an ideal methord for open fractures which is not suitable for internal fixation especial for the wounds in nature disasters.
引文
[1]胡裕桐,毛宾尧,王毳.超关节外固定架和有限内固定治疗膝关节骨折[J].中国矫形外科杂志,2000,12(7):1234-1235.
[2]SB NAIQUE,RT MADHAV,MF PEARSE.The management ofhigh-energy proximal tibial fractures by combined percutaneous in-ternal fixation and circular external fixation.[J].J Bone Joint Surg,2003,85-B:38-39.
[3]A PAPANIKOLAOU,G.THEODORATOS.Fractures of the tibi-al bondyles:treatment with external fixation and limited internal fi-cation[J].J Bone Joint Surg,2004,86-B:159.
[4]吴恒义.地震伤的特点和救治策略[J].创伤外科杂志,2008,10(5):413-415.
[5]袁福禄,韩广普,等.微创内固定系统治疗膝关节周围骨折[J].创伤外科杂志,2008,10(4):366.
[6]王序全,吴雪晖,等.微创内固定系统在膝关节周围骨折治疗中的初步应用[J].第三军医大学学报,2008,4(30):671-674.
[7]ROBERT V,KENNETH J..Minimally Invasive Liss Plating ForFractures Around The Knee[J].Techniques in Knee Surgery.2008,7(2):131-136.
[8]ETTER C,CLAES L,KINZL L,RAIBLE M.Treatment by exter-nal fication of open fracture Associated with Severe Soft TissueDamageof the Leg:Biomechanical Principles and Clinical Experience[J].Clin Ortho&Related Research,1983,9(178):80-88.
[2]SB NAIQUE,RT MADHAV,MF PEARSE.The management ofhigh-energy proximal tibial fractures by combined percutaneous in-ternal fixation and circular external fixation.[J].J Bone Joint Surg,2003,85-B:38-39.
[3]A PAPANIKOLAOU,G.THEODORATOS.Fractures of the tibi-al bondyles:treatment with external fixation and limited internal fi-cation[J].J Bone Joint Surg,2004,86-B:159.
[4]吴恒义.地震伤的特点和救治策略[J].创伤外科杂志,2008,10(5):413-415.
[5]袁福禄,韩广普,等.微创内固定系统治疗膝关节周围骨折[J].创伤外科杂志,2008,10(4):366.
[6]王序全,吴雪晖,等.微创内固定系统在膝关节周围骨折治疗中的初步应用[J].第三军医大学学报,2008,4(30):671-674.
[7]ROBERT V,KENNETH J..Minimally Invasive Liss Plating ForFractures Around The Knee[J].Techniques in Knee Surgery.2008,7(2):131-136.
[8]ETTER C,CLAES L,KINZL L,RAIBLE M.Treatment by exter-nal fication of open fracture Associated with Severe Soft TissueDamageof the Leg:Biomechanical Principles and Clinical Experience[J].Clin Ortho&Related Research,1983,9(178):80-88.
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