Bosse M J, Staeheli J W, Reinert C M
Department of Orthopedic Surgery, Naval Hospital Portsmouth, Virginia.
J Orthop Trauma. 1989;3(3):223-31. doi: 10.1097/00005131-198909000-00007.
We prospectively studied 20 patients whose selected unstable tibial diaphyseal fractures were treated with the combined techniques of minimal internal fixation and external fixation. Five fractures were closed and 15 were open (six Grades I and II, nine Grade III). Seventeen were due to high-energy injuries. The minimum followup was 2 years. All fractures healed, one with malalignment. Time to union averaged 12 weeks in closed fractures and 19 weeks in open fractures. All high-energy fractures underwent bone grafting. The external fixation was removed by dynamization. Thirteen complications occurred in nine patients, all with open fractures. Three of 120 pins became infected (2.5%). Early bone grafting and dynamization of the external fixation prevented the malunions and nonunions reported previously with this technique.
我们前瞻性地研究了20例选定的不稳定胫骨干骨折患者，这些患者采用了微创内固定和外固定相结合的技术进行治疗。其中5例骨折为闭合性骨折，15例为开放性骨折（6例为Ⅰ级和Ⅱ级，9例为Ⅲ级）。17例骨折由高能损伤所致。最短随访时间为2年。所有骨折均愈合，1例出现畸形愈合。闭合性骨折平均愈合时间为12周，开放性骨折为19周。所有高能骨折均接受了植骨治疗。通过动力化拆除外固定架。9例患者出现了13种并发症，均为开放性骨折。120根钢针中有3根发生感染（2.5%）。早期植骨和外固定架动力化预防了此前该技术所报道的畸形愈合和骨不连。
