Park Chul Hyun, Shon Oog Jin, Kim Gi Beom
Department of Orthopedic Surgery, Yeungnam University Hospital, Daegu, Korea.
Indian J Orthop. 2016 Sep;50(5):536-542. doi: 10.4103/0019-5413.189604.
Traditionally, Gustilo Anderson grade IIIb open tibial fractures have been treated by initial wide wound debridement, stabilization of fracture with external fixation, and delayed wound closure. The purpose of this study is to evaluate the clinical and radiological results of staged treatment using negative pressure wound therapy (NPWT) for Gustilo Anderson grade IIIb open tibial fractures.
15 patients with Gustilo Anderson grade IIIb open tibial fractures, treated using staged protocol by a single surgeon between January 2007 and December 2011 were reviewed in this retrospective study. The clinical results were assessed using a Puno scoring system for severe open fractures of the tibia at the last followup. The range of motion (ROM) of the knee and ankle joints and postoperative complication were evaluated at the last followup. The radiographic results were assessed using time to bone union, coronal and sagittal angulations and a shortening at the last followup.
The mean score of Puno scoring system was 87.4 (range 67-94). The mean ROM of the knee and ankle joints was 121.3° (range 90°-130°) and 37.7° (range 15°-50°), respectively. Bone union developed in all patients and the mean time to union was 25.3 weeks (range 16-42 weeks). The mean coronal angulation was 2.1° (range 0-4°) and sagittal was 2.7° (range 1-4°). The mean shortening was 4.1 mm (range 0-8 mm). Three patients had partial flap necrosis and 1 patient had total flap necrosis. There was no superficial and deep wound infection.
Staged treatment using NPWT decreased the risks of infection and requirement of flap surgeries in Gustilo Anderson grade IIIb open tibial fractures. Therefore, staged treatment using NPWT could be a useful treatment option for Gustilo Anderson grade IIIb open tibial fractures.
传统上，Gustilo Anderson IIIb型开放性胫骨骨折的治疗方法是初期进行广泛的伤口清创，采用外固定稳定骨折，并延迟伤口闭合。本研究的目的是评估采用负压伤口治疗（NPWT）分期治疗Gustilo Anderson IIIb型开放性胫骨骨折的临床和影像学结果。
本回顾性研究纳入了2007年1月至2011年12月期间由一名外科医生采用分期方案治疗的15例Gustilo Anderson IIIb型开放性胫骨骨折患者。在最后一次随访时，使用Puno评分系统评估胫骨严重开放性骨折的临床结果。在最后一次随访时评估膝关节和踝关节的活动范围（ROM）以及术后并发症。使用最后一次随访时的骨愈合时间、冠状面和矢状面成角以及短缩情况评估影像学结果。
Puno评分系统的平均得分为87.4分（范围为67 - 94分）。膝关节和踝关节的平均ROM分别为121.3°（范围为90° - 130°）和37.7°（范围为15° - 50°）。所有患者均实现骨愈合，平均愈合时间为25.3周（范围为16 - 42周）。平均冠状面成角为2.1°（范围为0 - 4°），矢状面成角为2.7°（范围为1 - 4°）。平均短缩为4.1毫米（范围为0 - 8毫米）。3例患者出现部分皮瓣坏死，1例患者出现完全皮瓣坏死。无浅表和深部伤口感染。
采用NPWT分期治疗可降低Gustilo Anderson IIIb型开放性胫骨骨折的感染风险和皮瓣手术需求。因此，采用NPWT分期治疗可能是Gustilo Anderson IIIb型开放性胫骨骨折的一种有效治疗选择。
