Tucker H L, Kendra J C, Kinnebrew T E
Orlando Regional Medical Center, Florida.
Clin Orthop Relat Res. 1992 Jul(280):125-35.
Forty-one consecutive tibial diaphyseal fractures that required operative stabilization were treated using the external fixator and concepts of compression-distraction of Ilizarov. Eleven fractures had bone loss greater than 1 cm and were managed by simultaneously compressing the fracture gap and distracting through a corticotomy site to maintain extremity length. Thirty tibial fractures consisted of closed unstable and open fractures that were managed using the external fixator, emphasizing immediate weight bearing and gradual compression at the fracture site. Twenty-six fractures in 23 patients were available for follow-up evaluation six to 9.5 months after bone healing. There were six closed, two Grade I, eight Grade II, five Grade IIIA, and five Grade IIIB fractures. Serial wound debridements, wet-to-dry-dressing changes, wound- and fracture-site compressions (13 fractures), and split-thickness skin grafts (eight wounds) were used to accomplish wound closure. Chronic infections did not occur. All fractures healed from 12 to 47 weeks without bone grafting. Eight transosseous fixation wires are used, only two of which transfixed significant muscle. Approximately 10% of the 248 wire sites became inflamed and nine wire sites were treated for infection with antibiotics, skin release around the offending wire, or wire removal. Three wires fractured and one wire was replaced. One ring sequestrum occurred and responded to curettement. Angulation of 7 degrees-9 degrees occurred in five fractures (19%). The results were good or excellent in 25 fractures. One patient with 9 degrees varus in a distal fracture refused correction. Operative time was 60 to 90 minutes after developing a satisfactory protocol for frame application. This method allows immediate functional stabilization of tibial diaphyseal fractures and postoperatively allows ease of fracture gap closure and compression. The frame can be left in place for the duration of the fracture care. Application of the Ilizarov external fixator is slightly more complicated than traditional large pin fixators and requires more attention to detail intraoperatively and postoperatively, but can be a versatile tool in the management of complex tibial shaft fractures.
41例需要手术稳定固定的胫骨干骨折采用外固定架及伊利扎罗夫（Ilizarov）加压撑开理念进行治疗。11例骨折骨缺损超过1cm，通过同时压缩骨折间隙并经皮质切开部位撑开以维持肢体长度来处理。30例胫骨干骨折包括闭合性不稳定骨折和开放性骨折，采用外固定架治疗，强调早期负重及骨折部位的逐渐加压。23例患者的26处骨折在骨愈合后6至9.5个月接受随访评估。其中有6例闭合性骨折、2例Ⅰ级骨折、8例Ⅱ级骨折、5例ⅢA级骨折和5例ⅢB级骨折。通过多次伤口清创、湿-干敷料更换、伤口及骨折部位加压（13处骨折）以及中厚皮片移植（8处伤口）实现伤口闭合。未发生慢性感染。所有骨折在12至47周内愈合，均未进行植骨。共使用8根穿骨固定钢丝，其中仅有2根穿过重要肌肉。248个钢丝部位中约10%出现炎症，9个钢丝部位因感染接受了抗生素治疗、在引起问题的钢丝周围进行皮肤松解或钢丝取出处理。3根钢丝断裂，1根钢丝被更换。出现1处环形死骨，经刮除治愈。5处骨折（19%）出现7度至9度的成角畸形。25处骨折的结果为良好或优秀。1例远端骨折出现9度内翻的患者拒绝矫正。在制定了满意的外固定架安装方案后，手术时间为60至90分钟。该方法可使胫骨干骨折立即获得功能稳定，术后便于骨折间隙闭合及加压。外固定架可在骨折治疗期间一直保留。伊利扎罗夫外固定架的应用比传统大针外固定架稍复杂，术中及术后需要更注重细节，但在复杂胫骨干骨折的治疗中是一种多功能工具。
