【摘要】 目的 :总结小腿开放骨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 15 2例( 82 % ) ;延期愈合 3 3例 ( 18% )。TypeⅢ°B骨折皮肤缺损Ⅰ期覆盖成活 18/ 2 3例 ( 78% ) ;Ⅱ期覆盖 8例全部成活( 10 0 % )。骨延迟愈合 18例 ( 9.9% ) ,骨不连 2 9例 ( 16% ) ,平均愈合时间 9.3个月。不同骨折类型骨愈合时间有显著差异 (x2 =5 2 .12 ,P <0 .0 1)。感染 17例 ( 9.6% ) ,Ⅰ°～Ⅲ°骨折感染率分别为 1.7%、5 .1%和 2 4% (x2 =18.4,P <0 .0 1) ;其中伤后 <6h手术感染 5例 ( 2 3 .5 % ) ,>6h手术 13例 ( 76.5 % ) (x2 =4.5 ,P <0 .0 5 )。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 .2 % )。Ⅰ～Ⅱ期截肢 4例 ( 2 .1% )。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 ,消灭创面。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。更多还原

【Abstract】 Objective: To improve treatment effectives of open fracture in legs through review chinical experience. Method: 185 cases who underwent plaster fixation, external and internal fixation with DCP were retrospectively studied between 1987.3～1996.5. Result:The wounds primary healing were 152(82%), delyed healing 33(18%). The survival of primarily transplanted skin for Type Ⅲ fracture were 88%, of secondary skin graft were 100%. The average fracture healing time were 9.3 months, in which delayed unions were 18(9.9%), nonunion 29(16%); There were no significant statistic difference for healing time among the various types ( x 2=52.12,P<0.01 ). The infective rates for type Ⅰ～Ⅲ were 1.7%,5.1% and 24% respectively ( x 2=18.4,P<0.01 ), of that 23.5% occurred in operation less than 6 hours after trauma, 76.5% in case more than 6 hours. The compartment syndrome were 6(3.2%). Amputation 5(2.7%). Overall, the complete recovery of leg function and employment were 84%. Conclusion: Early debridement, satisfactory reduction, rigid fixation, primarily skin and bone graft for their defect and preventive decompression of doubtful department syndrome were emphasized. Meanwhile, it is advisable that Type Ⅲc fracture which is difficult to reserved or survived a painful and no function leg should be amputated primarily in case secondary truma to the patients.更多还原