Heim D, Marx A, Hess P, Schläpfer R, Regazzoni P
Departement Chirurgie der Universität Kantonsspital Basel.
Helv Chir Acta. 1991 Feb;57(5):839-46.
The initial treatment of choice of fractures with severe soft tissue damage of the leg is the stabilization with an external fixator. After successful healing the question arises whether to continue the initial treatment with the external fixator to bone union or to change the initial concept by an internal fixation. Our experience with 62 fractures of the tibia (follow-up of 59 fractures) from 1985 to 1989 shows that 72% of the fractures were healed by the external fixator alone. Delayed union or pseudoarthrosis occurred in 17% and were mostly treated by late internal fixation. An analysis of the fracture types (new AO classification) did not show certain fracture types, that did not respond to the external fixator treatment alone. We conclude that the reason for a delayed union or pseudoarthrosis is less a morphological than a biological one. We recommend the first and final external fixator as treatment for fractures with severe soft tissue damage of the leg.
对于伴有严重小腿软组织损伤的骨折，最初选择的治疗方法是使用外固定器进行固定。骨折成功愈合后，就会出现是继续使用外固定器直至骨愈合，还是通过内固定改变最初治疗方案的问题。我们对1985年至1989年间62例胫骨骨折（59例进行了随访）的经验表明，72%的骨折仅通过外固定器就实现了愈合。17%出现了延迟愈合或骨不连，大多通过后期内固定进行治疗。对骨折类型（新的AO分类）的分析并未显示出某些仅靠外固定器治疗无效的骨折类型。我们得出结论，延迟愈合或骨不连的原因与其说是形态学上的，不如说是生物学上的。我们推荐将初次及最终的外固定器作为伴有严重小腿软组织损伤骨折的治疗方法。
