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1、小腿开放骨折临床治疗体会(附185例报告)中国矫形外科杂志2000年第8期第7卷论著作者：孙康汤欣孙立众黄辽江张羽飞刘谟震胡晓宇王鹏单位：孙康汤欣孙立众黄辽江张羽飞刘谟震(大连医科大学附属第一医院骨科116011)；胡晓宇(鞍山市第三人民医院骨科)；王鹏(盘锦市第二人民医院骨科)关键词：小腿；开放骨折；固定摘要目的：总结小腿开放忖折临床治疗经验以提高疗效。方法：对1987年3月〜1996年5月分别采用石膏、外固定架和加压钢板治疗并得以完整随访的小腿开放骨折185例病人进行回顾分析。结果：术后伤口I期愈合152例(82%)；延期愈合3
2、3例(18%)oTypeIII°B骨折皮肤缺损I期覆盖成活⑻23例(78%)；II期覆盖8例全部成活(100%)o骨延迟愈合18例(9.9%),骨不连29例(16%),平均愈合时间9.3个月。不同骨折类型骨愈合吋间有显著差异(x2=52.12,P<0.0I)o感染17例(9.6%),I°〜111°骨折感染率分别为1.7%、5.1%和24%(x2=18.4,P<0.01)；其中伤后V6h手术感染5例(23.5%),>6h手术13例(76.5%)(x2=4.5,P<0.05)。术后肢体功能和劳动力完全恢复占84%。术后筋膜综合征6例(3
3、.2%)。I〜II期截肢4例(2」％)。结论：小腿开放骨折应力争早期清创，满意的复位与坚强的固定。III。B骨折尽量I期皮肤覆盖，消灭创而。骨缺损时应酌情I期植骨，并提倡积极地I期筋膜切开以防止筋膜室高压。III。C保肢困难和残肢功能不全应果断地I期截肢以免二次创伤或减小病人的痛苦和费用。中图分类号R683.42文献标识码A文章编号1005-8478(2000)08-0765-03ClinicalExperienceinManagementofOpenFractureofLegsSUNKang,TANGXin,SUNLi-zhong
4、,etal(DepailmentOrthopedics.TheFirstAffiliatedHospital.DalianMedicalUniversity116011)AbstractObjective:Toimprovetreatmenteffectivesofopenfractureinlegsthroughreviewchinicalexperience.Method:185caseswhounderwentplasterfixation,externalandinternalfixationwithDCPwereretro
5、spectivelystudiedbetween1987.3~1996.5.Result:Thewoundsprimaryhealingwere152(82%),delyedhealing33(18%).ThesurvivalofprimarilytransplantedskinforTypeIIIfracturewere88%,ofsecondaryskingraftwere100%.Theaveragefracturehealingtimewere9.3months,inwhichdelayedunionswere18(9.9%
6、),nonunion29(16%);Therewerenosignificantstatisticdifferenceforhealingtimeamongthevarioustypes(x2=52.12,P<0.01).Theinfectiveratesfortype1〜IIIwere1.7%,5.1%and24%respectively(x2=18.4,P<0.01),ofthat23.5%occurredinoperationlessthan6hoursaftertrauma,76.5%incasemorethan6hours
7、.Thecompartmentsyndromewere6(3.2%).Amputation5(2.7%).Overall,thecompleterecoveryoflegfunctionandemploymentwere84%.Conclusion:Earlydebridement,satisfactoryreduction,rigidfixation,primarilyskinandbonegraftfortheirdefectandpreventivedecompressionofdoubtfuldepartmentsyndro
8、mewereemphasized.Meanwhile,itisadvisablethatTypelllcfracturewhichisdifficulttoreservedorsurvivedapainfulandnofunction
