开放骨胫腓骨折的二期处理.ppt

开放性胫骨骨折治疗方案 备注： ATLS：高级创伤与生命支持 BMP-2：骨形态发生蛋白2 NPWT：创面负压疗法 JBJS开放性骨折治疗最新指南 1. 伤后＞6小时清创，不一定增加术后感染率 2. 开放性骨折3小时内应尽早抗生素 3. 开放性胫骨骨折推荐使用髓内钉治疗 4. 髓内钉的扩髓与非扩髓，目前尚无明确结论 5. IIIA、IIIB型严重污染的骨折伴严重骨缺损时，推荐外固定治疗 6. 开放性骨折宜早期闭合创面 Raman Mundi. et al. JBJS Reviews. 2015, 3(2):1-7 骨折固定方式的选择需考虑2个条件 Melvin JS. et al. J Am Acad Orthop Surg, 2010, 18:10-19 同时满足2个条件：一期内固定 满足1个条件：临时外固定，择期更换内固定 2个条件都不满足：外固定 骨折固定方式的选择 Rockwood and Greene’s fractures in adults. 6th ed. Bhandari MGH, et al. JBJS(Br),2001,83:62-68. Clasper JC, et al. J Orthop Trauma,2005,19:140-144. British Orthopaedic Association: Standards for the management of open fractures of the lower limb. Ⅰ、Ⅱ型（内固定） Ⅲ型（内固定或外固定） 良好软组织覆盖 污染轻 软组织覆盖延迟 污染重 复杂骨折 内固定 外固定架 Bhandari MGH,et al.J Orthop Trauma,2005,19:140-144. Bhandari MGH,et al.JBJS(Br),2001,83:62-68. Clasper JC,et al.JInjury,2001,32:337-381. British Orthopaedic Association: Standards for the management of open fractures of the lower limb. 前 提：钉道无感染、软组织条件良好 英国创伤指南：7 天；建议不超过28天 专家建议： 14天内更换内固定 已存在针道感染：更换终末型外固定架 外固定转换为内固定时机选择 小结 一期内固定：同时满足 彻底清创+一期覆盖创面 合并多发伤：损伤控制(DCO)，先行外固定，更换内固定 更 换 时 机：外固定术后2周内 更 换 前 提：钉道无感染、软组织条件良好 开放骨折早期处理决定预后 Thanks for your attention！ * * Before choosing the treatment, we should understand some characters of trochanteric fracture, which affect the clinical results.90% of this facture need fixation, and since most patients were aged, severe osteoporosis existed. And early rehabilitation and weight-bearing needed. And these demand the fracture should be good reduction and fixed strongly, that means proper implants and place the implant correctly. * Before choosing the treatment, we should understand some characters of trochanteric fracture, which affect the clinical results.90% of this facture need fixation, and since most patients were aged, severe osteoporosis existed. And early rehabilitation and weight-bearing needed. And these de