Zhang Li-hai, Zhang Li-cheng, Chen Hua, Liang Xiang-dang, Guo Yi-zhu, Tao Sheng, Zhang Qun, Tang Pei-fu, Wang Yan
Department of Orthopedics and Trauma Surgery, People's Liberation Army General Hospital, Beijing 100853, China.
Zhonghua Wai Ke Za Zhi. 2010 May 1;48(9):647-50.
To report the clinical outcome of the treatment of compound ankle fractures by vacuum sealing drainage and spanning external fixator.
From April 2005 to April 2009, 19 cases of Gustilo type III compound ankle fractures were treated, with type IIIA in 10 cases, Type IIIB in 7 and Type IIIC in 2. All cases underwent emergency debridement, and had the fractures fixed with spanning external fixator following indirect reduction, the wound closed with vacuum sealing drainage and repaired through direct suture, split-thickness skin graft or flap transposition.
In this series, following VSD of 5.0 to 18.0 d (mean 10.3 d), 2 cases had their wounds closed by direct suture, 12 by skin graft and 3 by flap transposition. The other 2 cases had repeated wound debridement and multiple use of VSD, and had their wounds repaired by flap transposition. All the 19 cases were followed up for 8 to 36 months with an average of 26 months. All the fractures united 3.0 to 10.0 (mean 3.8) months. At the final follow-up functional evaluation of the affected ankle joints was performed only to find excellent in 9 cases, good in 5, fair in 4 and poor in 1.
Gustilo type III compound ankle fracture can effectively be treated with VSD and spanning external fixator.
报告封闭负压引流联合跨关节外固定架治疗复杂性踝关节骨折的临床疗效。
2005年4月至2009年4月,收治19例GustiloⅢ型复杂性踝关节骨折患者,其中ⅢA型10例,ⅢB型7例,ⅡIC型2例。所有患者均接受急诊清创,间接复位后用跨关节外固定架固定骨折,伤口采用封闭负压引流,之后通过直接缝合、中厚皮片移植或皮瓣转移修复。
本组患者经5.0至18.0天(平均10.3天)的封闭负压引流后,2例伤口直接缝合愈合,12例通过植皮愈合,3例通过皮瓣转移愈合。另外2例患者伤口反复清创并多次使用封闭负压引流,最终通过皮瓣转移修复。19例患者均获随访,随访时间8至36个月,平均26个月。所有骨折均在3.0至10.0个月(平均3.8个月)愈合。末次随访时对患侧踝关节进行功能评估,结果为优9例,良5例,可4例,差1例。
封闭负压引流联合跨关节外固定架可有效治疗GustiloⅢ型复杂性踝关节骨折。