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1、·602·中国矫形外科杂志 2003年5月第11卷第9期 OrthopJChin,Vol.11,No.9May2003·论 著·微创手术治疗儿童胫腓骨开放骨折张熙民 林坚平 陈剑飞 宋世锋 姚伦龙 摘 要 目的:介绍自1992～2001年,对146例儿童开放性胫腓骨骨折的治疗经验。方法:本组病例入院后尽早行伤口清创术,视伤后局部软组织条件及骨折端情况,选择不同的骨折固定方法,用自制骨水泥体外支架固定96例,单纯石膏固定23例,1～2枚螺丝钉内固定配合石膏外固定11例,经皮克氏针配合石膏外固定16例
2、。结果:经9个月～8年随访,除1例血管损伤并严重骨及软组织挤压伤,术后坏死再截肢外,145例骨折全部愈合。结论:对儿童胫腓骨开放骨折的治疗,应充分估计到儿童的自我修复矫正能力强、骨折愈合快的特点,骨折固定力求简单可靠,争取正确对位,尽量保持骨折局部血运及有可能成活的组织,不强求骨折解剖复位而加重破坏骨折端的血运。微创化手术可为骨折愈合提供优化的生物力学环境。关键词 儿童胫腓骨骨折; 微创手术中图分类号 R683.42文献标识码 A文章编号 1005-8478(2003)09-0602-02Treat
3、mentofChildren’sOpenFractureofTibiaandFibulabyMinimallyInvasiveSurgery∥ZHANGXi2min,LINJian2ping,CHENJian2fei,etal.DepartmentofOrthopaedicSurgery,People’sHospitalofHainanProvince,Haikou570311.AbstractObjective:Tointroducetherapeuticexperienceof146caseso
4、fchildren’sopenfractureoftibiaandfibulainthedepartmentfrom1992to2001.Methods:Allcasesundergonedebridementsasearlyaspossible.Differentfixationswerechosenaccordingtothelocalcircumstanceofsofttissue.Ninty2sixcasesusedself2madebonecementscombinedwithextern
5、alfixations.Pureplastersupportswereutilizedin23cases.In11cases,internalfixationby1～2piecesofscrewswerecombinedwithplastersupport.PercutaneousKirschner’swireswereusedconjointedwithplastersupportin16cases.Results:After9monthsto8yearsfollow2up,145casesoff
6、ractureswereunionexcept1caseshowedpostoperativelimbnecrosisthatresultinamputationbe2causeofinjuryofbloodvesselsandseverecrushtraumaofboneandsofttissue.Conclusions:Withregardtothetreatmentofchil2dren’sopenfractures,weshouldfullyevaluatethecharacteristic
7、sofchildren:strongabilitiesofself2repair、self2correctionandrapidfractureunion.Sothefixationoffractureshouldbesimpleandreliable.It’simportmanttotrycorrectparatopeandtrytopreservelocalcirculationandtissuewhichmaybealive.Don’tenforcetoanatomicalreductiont
8、hatwilldamagthecirculationoffracturetips.Minimallyinvasivesurgerycanprovidegoodenvironmentofbiologicalmechanicforfractureunion.KeywordsChildren’sfractureoftibiaandfibula;Minimallyinvasivesurgery 小腿开放性骨折在创伤骨科中较为多见,早期彻骨折部位:胫骨上1/322例;中1/3
