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开放性骨折的非接触式钢板固定技术

Noncontact plating technique in an open fracture.

作者信息

Tuhanioğlu Ümit, Oğur Hasan Ulaş, Çiçek Hakan, Seyfettinoğlu Fırat, Çiloğlu Osman, Kapukaya Ahmet

机构信息

Department of Orthopaedics and Traumatology, Adana Numune Training and Research Hospital, Adana, Turkey.

出版信息

Ther Clin Risk Manag. 2017 Jun 8;13:703-708. doi: 10.2147/TCRM.S136741. eCollection 2017.

DOI:10.2147/TCRM.S136741
PMID:28652756
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5472430/
Abstract

AIM

In comparison with closed fractures, open fractures have an increased risk of infection, there are soft tissue-related problems, and difficulties are experienced in union. The aim of this study was to evaluate and discuss the results of osteosynthesis applied with a noncontact plate in Gustilo-Anderson Type 2, 3a, and 3b fractures.

METHOD

The study included 23 patients applied with debridement + noncontact plate osteosynthesis + soft tissue procedures in a single session for the treatment of an open fracture. A follow-up card was created to evaluate the patients in respect of age, gender, fracture level, fracture etiology, open fracture type, preoperative and postoperative sedimentation and C-reactive protein values, antibiotics used and duration of use, time to union, and complications.

RESULTS

In all 23 patients, full bone union was obtained at mean 22.5 weeks (range: 16-36 weeks). Complications developed in 9 patients. Implant failure occurred in 3 patients. In 5 patients, infection developed which required repeated debridements.

CONCLUSION

In open fractures, noncontact plating following debridement seems to be a good alternative treatment method to intramedullar nailing, especially in metaphyseal and metaphyseo-diaphyseal fractures and in spiral oblique diafiz fractures. Noncontact plating may also be a good alternative to intramedullar nailing for open fracture treatment if the patients have additional pathologies such as contusion and thoracic injury.

摘要

目的

与闭合性骨折相比,开放性骨折感染风险增加,存在软组织相关问题,且愈合困难。本研究的目的是评估和讨论应用非接触钢板治疗 Gustilo-Anderson 2 型、3a 型和 3b 型骨折的接骨术结果。

方法

本研究纳入 23 例患者,对其开放性骨折进行一期清创 + 非接触钢板接骨术 + 软组织处理。创建随访卡以评估患者的年龄、性别、骨折部位、骨折病因、开放性骨折类型、术前和术后血沉及 C 反应蛋白值、使用的抗生素及使用时间、愈合时间和并发症情况。

结果

所有 23 例患者均获得完全骨愈合,平均愈合时间为 22.5 周(范围:16 - 36 周)。9 例患者出现并发症。3 例患者发生内固定失败。5 例患者发生感染,需要反复清创。

结论

在开放性骨折中,清创后采用非接触钢板固定似乎是髓内钉固定的一种良好替代治疗方法,尤其适用于干骺端和干骺 - 骨干骨折以及螺旋斜形骨干骨折。如果患者有其他合并症,如挫伤和胸部损伤,非接触钢板固定也可能是开放性骨折治疗中髓内钉固定的良好替代方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5766/5472430/f965bd5811ff/tcrm-13-703Fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5766/5472430/f965bd5811ff/tcrm-13-703Fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5766/5472430/f965bd5811ff/tcrm-13-703Fig1.jpg

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Prevention of Infection in Open Fractures.开放性骨折的感染预防
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Unreamed Intramedullary Nailing is a better alternative than External Fixator for Gustilo grade IIIB Tibial Fractures based on a meta-analysis.基于一项荟萃分析,对于 Gustilo ⅢB 型胫骨骨折,非扩髓髓内钉固定是比外固定架更好的选择。
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