Kaftandziev I, Pejkova S, Saveski J
Traumatology Clinic, Clinical Centre, Medical Faculty, Skopje, R. Macedonia.
Prilozi. 2006 Jul;27(1):121-31.
Open fractures, especially III grade open fractures of the tibial diaphysis, according to the Gustilo classification still remains a serious therapeutic problem. The aim of the study was to evaluate the clinical results after operative treatment of III grade open fractures of diaphysis of the tibia and to promote a new method of fracture fixation.
48 patients with open fractures of the tibial diaphysis, classified as type III A and B, according to the Gustilo classification, were operatively treated. Patients were divided into two groups depending on the manner of fracture fixation. Patients in group A (30 pts.) were treated with an external fixator and those in group B (18 pts.) with unreamed intramedullary nails. The time of the union of the fracture, problems with the union (malunion and nonunion), infection, different complications and the functional outcome were examined. Late complications and their treatment were not the object of the study. The follow-up period was at least 12 months. The results of the study showed a mean time of union of 38.4 weeks in patients in group A, and 32.8 for those in group B. Malunion was noticed in 5 (16.6%) in group A and 2 (11.1%) in group B, nonunion in 4 (13.35) in group A and in 2 (11.1%) patients in group B. Superficial infection developed in 7 (23.3%) and deep in 6 (20%) of the patients in group A and in group B in 4 (22.2%) and 2 (11.1%) of the patients. Results from the functional examination showed 26.6% excellent and the same percent of fair results in group A. In group B there were 55.5% excellent and 11.1% fair results. Different types of complications were noticed in the patients from both groups. The final results of the examination showed a shorter time of union, a lower percentage of complications and a better functional outcome in the patients in group B. Unreamed intramedullary interlocking nailing of open fractures of the diaphysis of the tibia (grade III A and B according Gustilo classification) is a relatively safe method of operative treatment with fewer complications compared with external fixation.
开放性骨折，尤其是胫骨干的Ⅲ级开放性骨折，根据 Gustilo 分类法，仍然是一个严重的治疗难题。本研究的目的是评估胫骨干Ⅲ级开放性骨折手术治疗后的临床结果，并推广一种新的骨折固定方法。
对 48 例根据 Gustilo 分类法归类为ⅢA 型和ⅢB 型的胫骨干开放性骨折患者进行了手术治疗。根据骨折固定方式将患者分为两组。A 组（30 例）采用外固定器治疗，B 组（18 例）采用非扩髓髓内钉治疗。检查骨折愈合时间、愈合问题（畸形愈合和不愈合）、感染、不同并发症及功能结果。晚期并发症及其治疗不是本研究的对象。随访期至少 12 个月。研究结果显示，A 组患者的平均愈合时间为 38.4 周，B 组为 32.8 周。A 组有 5 例（16.6%）出现畸形愈合，B 组有 2 例（11.1%）；A 组有 4 例（13.35%）出现不愈合，B 组有 2 例（11.1%）。A 组 7 例（23.3%）患者发生浅表感染，6 例（20%）发生深部感染；B 组 4 例（22.2%）患者发生浅表感染，2 例（11.1%）发生深部感染。功能检查结果显示，A 组 26.6%为优，同样比例为良。B 组 55.5%为优，11.1%为良。两组患者均出现了不同类型的并发症。检查的最终结果显示，B 组患者的愈合时间更短，并发症发生率更低，功能结果更好。胫骨干开放性骨折（根据 Gustilo 分类法为ⅢA 型和ⅢB 型）的非扩髓髓内交锁钉固定术是一种相对安全的手术治疗方法，与外固定相比并发症更少。
