【摘要】 目的观察负压吸引结合微创分期策略治疗胫腓骨开放性骨折的疗效。方法回顾性分析2010年3月~2014年5月收治的60例Gustilo-ⅢA和ⅢB型开放性胫腓骨骨折病例的临床资料,其中男性32例,女性28例;年龄18~65岁,平均30.6岁。采用负压创面治疗技术结合微创分期策略治疗,Ⅰ期手术彻底清创,使用克氏针、螺钉、钢丝或可吸收线进行有限固定。然后按照创面的大小安装合适的负压吸引装置。术后应用抗生素预防感染治疗,1周后打开负压封闭吸引装置,观察肉芽组织生成情况,视伤口情况再次进行负压封闭引流(VSD)覆盖或行植皮、皮瓣转移覆盖。Ⅱ期手术应用锁定加压钢板或微创内固定系统(LISS)钢板进行闭合复位经皮微创插入钢板内固定术。观察疗效和并发症,探讨该术式适应证和并发症的防治,并进行1年以上的随访,观察其远期疗效。结果负压吸引结合微创分期策略治疗胫腓骨开放性骨折住院时间短,治疗费用少,术后并发症少,骨折愈合快,平均愈合时间7.2个月。结论负压创面治疗技术结合微创分期策略治疗高能量胫腓骨开放性骨折安全微创、简单、切实可行,且并发症相对较少,值得推广。更多还原

【Abstract】 Objective To investigate the curative effect of minimally invasive treatment combined with vacuum sealing drainage for open tibiofibular fractures based on staging strategy. Methods Data of 60 patients with high-energy open tibiofibular fractures of Gustilo-ⅢA or ⅢB who were admitted from Mar. 2010 to May 2014 was retrospectively analyzed. There were 32 males and 28 females,with age ranging from 18 to 65 years( average,30. 6years). Patients were treated with minimally invasive treatment combined with vacuum sealing drainage based on staging strategy. Stage I: radical debridement was applied; Kirschner wires,screws,wires or absorbable sutures were used to fix the fractures temporarily. Then,the vacuum sealing drainage was put on the surface of the open wound.Antibiotics were used to prevent infection after the surgery. One week later,the vacuum sealing drainage was removed to observe the situation of granulation tissue formation. The re-application of vacuum sealing drainage,skin graft or skin flap transfer was performed based on the wound conditions. Stage Ⅱ: locking compression plate or less invasive stabilization system( LISS) plate was used for closed reduction and internal fixation with minimally invasive percutaneous plate osteosynthesis techniques. The curative effects and complications were observed and the indications and treatment strategy for complications were analyzed. Furthermore,all patients were followed up with a minimum of one year to observe the long-term effect. Results Minimally invasive treatment combined with vacuum sealing drainage for open fractures of tibia and fibula based on staging strategy has the advantages of shorter hospital stay,lower cost,less complications and faster fracture healing( average 7. 2 months). Conclusion Minimally invasive treatment combined with vacuum sealing drainage for treating open fractures of tibia and fibula based on staging strategy is safe,simple and applicable,and it is worth promoting.更多还原