Cramer K E, Limbird T J, Green N E
Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2550.
J Bone Joint Surg Am. 1992 Feb;74(2):218-32.
We reviewed the results of treatment of forty open diaphyseal fractures of the lower extremity in thirty-five children. The patients were between three and sixteen years old, and they had been managed between 1980 and 1988. The minimum duration of follow-up was one year. Eighty-six per cent of the patients had been injured in a motor-vehicle accident, and 74 per cent had associated injuries. Thirty-one of the fractures were Grade-II open or Grade-III open and seven were Grade-I open, according to the classification of Gustilo and Anderson. Two patients who had initially had a closed fracture were treated with a fasciotomy for a compartment syndrome, so these two fractures were included as open. Four other patients who had a Grade-II or III open fracture also needed a fasciotomy. All wounds were treated with immediate and repeat débridement and early soft-tissue coverage. Twenty-two fractures healed primarily. There were three early amputations. Twelve fractures that healed after six months were classified as delayed unions and three fractures were classified as non-unions because of the absence or arrest of healing, as seen on serial roentgenograms. Additional intervention was used to achieve union of eight of the fifteen fractures that had been classified as a delayed union or a non-union. Ten of the forty fractures were associated with infection, but osteomyelitis developed in only one patient. No patient had a growth arrest. Only one patient had a limb-length discrepancy that was more than two centimeters. Three early amputations and one delayed amputation were performed in patients who had a Grade-IIIC open fracture.
我们回顾了35名儿童下肢40例开放性骨干骨折的治疗结果。患者年龄在3岁至16岁之间，于1980年至1988年接受治疗。最短随访时间为1年。86%的患者因机动车事故受伤，74%的患者伴有其他损伤。根据Gustilo和Anderson的分类，31例骨折为Ⅱ级开放性或Ⅲ级开放性骨折，7例为Ⅰ级开放性骨折。2例最初为闭合性骨折的患者因骨筋膜室综合征接受了筋膜切开术，因此这2例骨折被列为开放性骨折。另外4例Ⅱ级或Ⅲ级开放性骨折的患者也需要进行筋膜切开术。所有伤口均立即进行清创并反复清创，并早期进行软组织覆盖。22例骨折一期愈合。有3例早期截肢。12例在6个月后愈合的骨折被归类为延迟愈合，3例骨折因连续X线片显示无愈合或愈合停滞而被归类为不愈合。对于15例被归类为延迟愈合或不愈合的骨折中的8例，采用了额外的干预措施以实现骨折愈合。40例骨折中有10例伴有感染，但仅1例患者发生骨髓炎。没有患者出现生长停滞。只有1例患者的肢体长度差异超过2厘米。3例ⅢC级开放性骨折患者进行了早期截肢，1例进行了延迟截肢。
