胫骨下段粉碎性骨折手术治疗.docVIP

胫骨下段粉碎性骨折手术治疗 　 作者：王欣，俞光荣，曾至立，张世民，杨云峰，马仁治 【关键词】 胫骨骨折 摘 要：［目的］探讨胫骨下段粉碎性骨折的治疗方法和临床疗效。［方法］回顾本院自2004年5月～2005年2月，对30例胫骨下段粉碎性骨折的患者进行手术治疗。选择合适的手术时机，延期切开复位应用胫骨远端内侧解剖型钢板内固定，并对所有患者进行预防性植骨。［结果］术后随访8～17个月，平均139个月，伤口均一期愈合，所有病例获得骨性愈合，平均愈合时间127周(9～16周)。按Mazur评分标准：优22例，良6例，可2例，差0例，优良率933％，所有患者无严重并发症。［结论］胫骨远端内侧解剖型钢板是治疗胫骨下段骨折的理想内固定物，选择合适的手术时机、预防性植骨是取得满意疗效的保证。 关键词：胫骨骨折； 骨折固定术； 内； 手术治疗 Abstract：［Objective］To investigate the curative effect and methods of distal tibial fracture by operation.［Method］From May 2004 to Feb.2005, 30 cases of distal tibial fracture were treated in the department. All cases were treated with open reduction, internal fixation with medial anatomic plates, and with bone-grafting prophylacticly in all cases. The operation would be done on 10~14 days after fracture.They were followed up and analyzed retrospectively.［Result］All cases were followed up for 8～17 months (average 13.9 months). All wounds were primary healing and all fractures obtained boneunion. Twentytwo cases were the excellent, 6 cases were the good according to Mazur’s criteria. The excellent and good rate was 93.3%. All cases had no severe complication, such as wound infection, cutaneous necrosis and bone nonunion.［Conclusion］Anatomic plate of distal tibia is a perfect choice for treatment of distal tibial fracture. Operative juncture and prophylactic bone grafting were very important to obtain satisfactory effect. Key words：Tibial fracture； Fracture fixation； Internal； Operative treatment 胫骨下段粉碎性骨折是临床常见急症之一。由于胫骨下段血供差、胫骨前方软组织薄弱以及骨折粉碎等原因，若处理不当，极易发生创口感染、皮肤坏死、骨折延迟愈合或不愈合等并发症。2004年5月～2005年2月，本院共收治30例胫骨下段粉碎性骨折的患者，进行手术治疗，取得了满意的效果，进行回顾分析，报道如下： 1 临床资料 11 一般资料 本组病例共30例，均为新鲜骨折，男21例，女9例，年龄21～62岁，平均39岁。左侧17例，右侧13例。开放性骨折19例，闭合性骨折11例。致伤原因：车祸伤18例，重物砸伤3例，扭转暴力6例，摔伤3例。所有患者术前均摄胫腓骨正、侧位片，胫骨骨折线远端距离踝关节胫骨面约2～6 cm。骨折按AO分类：B1型7例，B2型4例，B3型12例，C1型4例，C3型3例；合并腓骨骨折21例，其中腓骨中下段骨折15例，腓骨上端骨折6例。开放性骨折按Gustilo分类：Ⅰ型6例，Ⅱ型9例，ⅢA型3例，ⅢB型1例，ⅢC型0例。 12 治疗方法 若为开放性骨折，急诊彻底清创缝合伤口或皮瓣转移覆盖创面，使变为闭合性骨折，石膏外固定并抬高患肢置于牵引架上，如短缩移位明显或伴有骨缺损时需行持续跟骨牵引。常规应