Duncan R, Geissler W, Freeland A E, Savoie F H
University of Mississippi Medical Center, Jackson 39216.
J Orthop Trauma. 1992;6(1):25-31.
Immediate (within 24 h) open reduction and internal fixation of 103 open fractures of one or both bones of the forearm was accomplished in 69 patients between 1980 and 1989. Fifty-four of the 103 patients were reevaluated 1 to 7 years postinjury (average 2.5 years) to determine the efficacy of this treatment. Forty-five (90%) of the 50 patients with Grade I, II, or IIIA injuries had satisfactory results. The four patients with Grade IIIB or IIIC injuries had unacceptable results. This study demonstrates, as have previous investigations, that immediate open reduction and internal fixation of open forearm fractures provide acceptable results in Grades I, II, and selected Grade III injuries. The subdivision of Grade III fractures into A, B, and C types provides a previously unreported statistically significant difference in the results obtained in management of these injuries. The difference in results in Grade I, II, and IIIA injuries as compared to the Grade IIIB and C injuries was statistically significant (p = 0.0004). The difference in Grade IIIA injuries as compared to Grade IIIB and C injuries was also significant (p = 0.014). Immediate open reduction and internal fixation can be recommended in Grade I, II, and IIIA open forearm fractures. Although it is unclear from this report whether the results in Grade IIIB and C fractures were due to the management protocol, the severity of the initial injury, or combined factors, immediate open reduction and plate fixation yielded poor results in these injuries.
1980年至1989年间，69例患者的103处前臂单骨或双骨开放性骨折接受了即时（24小时内）切开复位内固定术。103例患者中的54例在受伤后1至7年（平均2.5年）接受了重新评估，以确定该治疗方法的疗效。50例I级、II级或IIIA级损伤患者中有45例（90%）取得了满意的结果。4例IIIB级或IIIC级损伤患者的结果不理想。本研究与之前的调查一样表明，前臂开放性骨折即时切开复位内固定术在I级、II级和部分III级损伤中能取得可接受的结果。将III级骨折细分为A、B和C型，在这些损伤的治疗结果中显示出之前未报告的统计学显著差异。I级、II级和IIIA级损伤与IIIB级和C级损伤的结果差异具有统计学意义（p = 0.0004）。IIIA级损伤与IIIB级和C级损伤的差异也具有统计学意义（p = 0.014）。对于I级、II级和IIIA级前臂开放性骨折，可推荐即时切开复位内固定术。尽管本报告尚不清楚IIIB级和C级骨折的结果是由于治疗方案、初始损伤的严重程度还是综合因素所致，但即时切开复位钢板固定术在这些损伤中效果不佳。
