Professor, Yantaishan Hospital, Yantai, PR China; Professor, Yantai Sino-French Friendship Hospital, Yantai, PR China.
Surgeon, Yantaishan Hospital, Yantai, PR China; Surgeon, Yantai Sino-French Friendship Hospital, Yantai, PR China.
J Foot Ankle Surg. 2020 Mar-Apr;59(2):409-412. doi: 10.1053/j.jfas.2019.08.016.
Gustilo grade IIIB open tibial fractures are relatively difficult to treat. We investigated the treatment effects of tibial intramedullary nails combined with vacuum sealing drainage (VSD) for Gustilo grade IIIB open tibial fractures. From March 2015 to March 2017, 13 cases of Gustilo grade IIIB open tibial fractures were treated with Expert Tibial Nails combined with VSD. Causes of injury included falls from a height (n = 9, 69.2%) and road accidents (n = 4, 30.8%). The duration from time of injury to hospital intake was 7.3 hours (range 5 to 9.5), and the time between injury and operation was 6.7 days (range 3 to 11). Six months after the operation, overall patient general health was investigated via the American Orthopaedic Foot and Ankle Society (AOFAS) ankle score and the physical and mental health dimensions of the Short-Form Health Survey 36 (SF-36). Postoperative complications and infections also were recorded. The results indicated that the median AOFAS score was 93.7 (range 89 to 97), with all individuals having either excellent (90 to 100; n = 10, 76.9%) or good (80 to 89; n = 3, 23.1%) outcomes. The median physical SF-36 score was 83.1 (range 72.5 to 93.0), and the median mental SF-36 score was 80.6 (range 69.7 to 92.0). Moreover, there were no instances of tibial shortening, neurovascular injury, postoperative complications, implant failure, malunion, or serious infections. In conclusion, intramedullary tibial nail combined with VSD is a safe and effective method to treat type grade IIIB open tibial fractures.
Gustilo ⅢB 型开放性胫骨骨折较难治疗。我们研究了交锁髓内钉联合负压封闭引流（VSD）治疗 Gustilo ⅢB 型开放性胫骨骨折的治疗效果。2015 年 3 月至 2017 年 3 月，采用交锁髓内钉联合 VSD 治疗 Gustilo ⅢB 型开放性胫骨骨折 13 例。受伤原因包括高处坠落（n=9，69.2%）和交通事故（n=4，30.8%）。受伤至入院时间为 7.3 小时（59.5 小时），受伤至手术时间为 6.7 天（311 天）。术后 6 个月，采用美国矫形足踝协会（AOFAS）踝关节评分和健康调查简表 36（SF-36）的生理和心理健康维度评估患者总体健康状况。记录术后并发症和感染情况。结果显示，AOFAS 评分中位数为 93.7 分（8997 分），优（AOFAS 评分 90100 分）10 例（76.9%），良（AOFAS 评分 8089 分）3 例（23.1%）。SF-36 生理评分中位数为 83.1 分（72.593.0 分），SF-36 心理评分中位数为 80.6 分（69.7~92.0 分）。无胫骨短缩、神经血管损伤、术后并发症、内固定失败、愈合不良或严重感染。结论：交锁髓内钉联合 VSD 是治疗 Gustilo ⅢB 型开放性胫骨骨折的安全有效方法。
