Rao P, Schaverien M V, Stewart K J
Department of Plastic and Reconstructive Surgery, Royal Hospital for Sick Children, Edinburgh, UK.
Ann R Coll Surg Engl. 2010 May;92(4):320-5. doi: 10.1308/003588410X12664192075017.
The management of open tibial fractures in children represents a unique reconstructive challenge. The aim of the study was to evaluate the management of paediatric open tibial fractures with particular regard to soft tissue management.
A retrospective case-note analysis was performed for all children presenting with an open tibial fracture at a single institution over a 20-year period for 1985 to 2005.
Seventy children were reviewed of whom 41 were males and 29 females. Overall, 91% (n = 64) of children suffered their injury as a result of a vehicle-related injury. The severity of the fracture with respect to the Gustilo classification was: Grade I, 42% (n = 29); Grade II, 24% (n = 17); Grade III, 34% (n = 24; 7 Grade 3a, 16 Grade 3b, 1 Grade 3c). The majority of children were treated with external fixation and conservative measures, with a mean hospital in-patient stay of 13.3 days. Soft tissue cover was provided by plastic surgeons in 31% of all cases. Four cases of superficial wound infection occurred (6%), one case of osteomyelitis and one case of flap failure. The limb salvage was greater than 98%.
In this series, complications were associated with delayed involvement of plastic surgeons. Retrospective analysis has shown a decreased incidence of open tibial fractures which is reported in similar studies. Gustilo grade was found to correlate with length of hospital admission and plastic surgery intervention. We advocate, when feasible, the use of local fasciocutaneous flaps (such as distally based fasciocutaneous and adipofascial flaps), which showed a low complication rate in children.
儿童开放性胫骨骨折的治疗是一项独特的重建挑战。本研究的目的是评估儿童开放性胫骨骨折的治疗，尤其关注软组织的处理。
对1985年至2005年期间在单一机构就诊的所有开放性胫骨骨折儿童进行回顾性病例分析。
共纳入70例儿童，其中男性41例，女性29例。总体而言，91%（n = 64）的儿童因交通事故受伤。根据 Gustilo 分类法，骨折严重程度为：I 级，42%（n = 29）；II 级，24%（n = 17）；III 级，34%（n = 24；7例3a级，16例3b级，1例3c级）。大多数儿童接受了外固定和保守治疗，平均住院时间为13.3天。31%的病例由整形外科医生提供软组织覆盖。发生4例浅表伤口感染（6%），1例骨髓炎和1例皮瓣坏死。肢体挽救率大于98%。
在本系列研究中，并发症与整形外科医生介入延迟有关。回顾性分析显示，开放性胫骨骨折的发生率较类似研究有所降低。发现 Gustilo 分级与住院时间和整形外科手术干预相关。我们主张在可行的情况下，使用局部筋膜皮瓣（如远端蒂筋膜皮瓣和脂肪筋膜皮瓣），其在儿童中的并发症发生率较低。
