Yıldırım Azad, Kapukaya Ahmet, Mertsoy Yılmaz, Yiğit Şehmus, Çaçan Mehmet Akif, Atiç Ramazan
Department of Orthopaedics and Traumatology, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey.
Department of Orthopaedics and Traumatology, Medical Faculty, Dicle University, Diyarbakır, Turkey.
Indian J Orthop. 2017 May-Jun;51(3):312-317. doi: 10.4103/0019-5413.205686.
The treatment of open fractures leads to major problems which may be due to various reasons. It mainly causes soft tissue problems due to the absorption of a large amount of energy by the soft tissues and bone tissues. Although some recent treatment protocols have eliminated many problems regarding delayed soft tissue closure, it still remains a big challange. This study uses a method called the internal fixator technique with noncontact locking plate (NC-LP) which involves the use of a combination of advantages of open and closed fixation techniques.
42 patients (32 men and 10 women) having a mean age of 34.11 years (range 17-56 years) with open fractures operated using internal fixator technique between 2007 and 2012 were included in this study. A retrospective chart review was conducted to record the following: age, gender, anatomic region of fractures, fracture etiology, classification of open fractures by Gustilo-Anderson and AO classification, surgeries, length of hospitalization, location and pattern of fracture, length of followup, and complications.
The fractures were caused by traffic accidents, shotgun injuries, falls from heights, and industrial crush injuries. Based on the Gustilo-Anderson classification, 31 fractures were Type III and 11 were Type II, where 23 were localized in the tibia and 19 in the femur. Patients delay for a mean of 13.5 h (range 6-24 h) for operation and the mean followup interval was 27.8 months (range 16-44 months). The mean union time was 19.7 weeks (range 16-29 weeks). One patient had delayed union and implant failure, one patient had osteomyelitis, five suffered from surface skin necrosis, and one patient had an angulation of 17° in the sagittal plane, for which no additional intervention was performed.
This case series demonstrates that an "internal fixator technique" is an acceptable alternative to the management of open fractures of the femur or tibia in adult patients. The NC-LP method provided opportunities to achieve a stable fixation with noncontact between the implant and the bone tissues, and the fractures were sufficiently stabilized to allow union with a low complication rate.
开放性骨折的治疗会引发诸多重大问题，其原因可能多种多样。主要是由于软组织和骨组织吸收大量能量，导致软组织问题。尽管近期一些治疗方案已消除了许多与软组织延迟闭合相关的问题，但这仍是一项巨大挑战。本研究采用一种名为带非接触锁定钢板（NC-LP）的内固定技术，该技术结合了开放和闭合固定技术的优势。
本研究纳入了2007年至2012年间采用内固定技术治疗开放性骨折的42例患者（32例男性，10例女性），平均年龄34.11岁（范围17 - 56岁）。通过回顾病历记录以下内容：年龄、性别、骨折的解剖部位、骨折病因、根据Gustilo-Anderson和AO分类法对开放性骨折的分类、手术情况、住院时间、骨折部位和类型、随访时间以及并发症。
骨折由交通事故、枪击伤、高处坠落和工业挤压伤所致。根据Gustilo-Anderson分类法，31例骨折为Ⅲ型，11例为Ⅱ型，其中23例位于胫骨，19例位于股骨。患者平均手术延迟时间为13.5小时（范围6 - 24小时），平均随访间隔为27.8个月（范围16 - 44个月）。平均愈合时间为19.7周（范围16 - 29周）。1例患者出现延迟愈合和内固定失败，1例患者发生骨髓炎，5例患者出现体表皮肤坏死，1例患者矢状面成角17°，未进行额外干预。
该病例系列表明，“内固定技术”是成年患者股骨或胫骨开放性骨折治疗的一种可接受的替代方法。NC-LP方法提供了在植入物与骨组织不接触的情况下实现稳定固定的机会，骨折得到充分稳定，以低并发症率实现愈合。
