四肢高能量粉碎性骨折分期与一期内固定治疗的疗效比较.pdf

江医学2013 年第35 卷第3 期 四肢高能量粉碎性骨折分期与 一期内固定治疗的疗效比较 邵金祥 张维康 朱云森 蒋正辉 【摘要 】 目的 探讨四肢高能量粉碎性骨折分期治疗的疗效及处理要点。 方法 对收治的49 例四肢高能量粉碎性骨折患 者，21 例行分期治疗，28 例行一期内固定治疗，术后随访时按相关功能评分进行疗效评价并比较。 结果 分期治疗组获得随访 （16.0 ±2.3 ）个月，所有患者均获得骨性愈合，疗效优8 例，良7 例，优良率71.4% ，仅发生皮肤坏死 1 例，并发症发生率4.8%。一期内 固定组获得随访（15.0 ±1.3 ）个月，疗效优7 例，良10 例，优良率60.7% ，发生皮肤坏死4 例，死亡 1 例，骨不愈 1 例，创口感染3 例（保 守治疗难以控制改外固定支架外固定，畸形愈合），并发症发生率32.1%。分期治疗组疗效优良率略高于一期内固定组，而并发症发生 率明显低于一期内固定组（P 0.05 ）。结论 分期治疗四肢高能量粉碎性骨折的临床效果确切，外固定支架固定转换时机应个体化， 并须重视关节内骨折的处理及骨质缺损植骨方 和时机的选择。 【关键词】 分期治疗 高能量 骨折 Comparison of staged management with early stage internal fixation in patients with high-energy extremity fractures China 【Abstract 】 Objective To compare the efficacy of staged management with early stage internal fixation in patients with high-energy extremity fractures. Methods Forty-nine patients with high-energy fractures were included in the study, including 21 cases treated with staged management and 28 cases treated with internal fixations in the early stage. All patients were fol- lowed up and related functions were evaluated. Results Patients in staged management were followed up for 16.0 ±2.3 months, all patients obtained bone union without infection with the satisfactory rate of 71.4% . The overall complication rate was 4.8% , in- cluding one patient with skin necrosis. Patients with early internal fixation were followed up for 15.0 ±1.3 months and 60.7% pa- tients obtained satisfactory results. The complication rate was 32.1% in this group of patients; there were 4 patients with skin necrosis, one patients with bone unhealed,3 patients with infection and 1 patient died. There were significant differences in com- plication rate between two groups P 0.05 ）. Conclusion Staged management is an effective surgical approach in treatment o