单一后外入路治疗胫腓骨远端骨折临床体会.docVIP

单一后外侧入路治疗胫腓骨远端骨折临床体会 王新亮 刘永轶 邝炯祥 张光明 侯之启 广州是第一人民医院 【摘要】 目的：探讨后外侧入路治疗胫腓骨下段开放性骨折的优缺点。材料与方法：本组28例28处，男15例，女13例，均为新鲜胫腓骨下段开放性骨折，按照Gustilo分型，Ⅱ型10例，ⅢA型10例，ⅢB型8例；按AO分型，43A3型21例，43C1型7例。所有骨折均Ⅰ期清创缝合和外固定，待消肿后Ⅱ期经后外侧入路内固定治疗。结果：全部病例获12-41个月随访（平均随访23个月），骨折均获愈合，平均愈合时间为4.9个月。无感染和其他软组织并发症发生，1例因严重伸肌腱损伤并足下垂，术后半年行跟腱延长和肌腱转位术，术后2年发生创伤性关节炎而行胫距关节融合术。按照美国足踝外科协会(American OrthopaedicFoot and Ankle Society, AOFAS)制定的前足-踝评分系统评价，优15例，良9例，可3例，差1例，优良率85.7％。结论：Ⅱ期经后外侧入路切开复位内固定是治疗胫腓骨下段开放性骨折的一个有效方法，它固定牢靠，术后软组织并发症少，踝关节功能恢复满意。 【关键词】 胫骨；腓骨；开放性骨折；手术入路 The preliminary clinical application of single-incision posterolateral approach on distal tibia and fibula open fractures Department of orthopedics, The Guangzhou First People’s Hospital, Guangzhou 510180. 【Abstract 】Objective: To study the advantage and shortage of the treatment of distal tibia and fibula open fractures through a posterolateral approach. Methods：28 cases in this group, From July 2003 to September 2005,24 cases of distal tibia and fibula open fractures was reviewed, which involved13 males and 11 females with an average age of 38.2 years（range 18-56 years） . According to Gustilo classification ,there wereⅡin 7, ⅢA in 7 and ⅢB in 10.The open reduction and internal fixation though single-incision posterolateral approach were performed within 10 days after injury. Results：All the cases were fellow uped 6－32 months（average，17 months）， the fractures healed well，no infection happed and ankle function recovered satisfactorily. According to Baird scoring system，15 were assessed as excellent，good 6 and 3 fair，and the excellent－good rate was 87.5％.Conclusion： The technique of treating distal tibia and fibula open fractures through single posterolateral approach offers many advantages, such as sufficient exposure, anatomical reduction ,stable fixation, less wound complications, earlier exercise and satisfactory ankle function . 【Key words】: tibia ;fibula ;open fractures ;surgical approach 胫腓骨下段开放性骨折小腿前方皮肤软组织损伤常常比较严重，经常规前内侧或前外侧切口治疗该类骨折往往会出现较多软组织并发症。2003