外固定架作为确定性治疗或外固定架固定后早期固定胫骨骨干开放性骨折：描述性研究。

External fixation as definitive treatment or external fixation followed by early fixation in open fractures of the tibial shaft: A descriptive study.

机构信息

Centre de Chirurgie orthopédique et traumatologie, Centre Hospitalo-Universitaire Nord, Marseille, Hôpital Nord, Chemin des Bourrely, 13915, Marseille, France.

出版信息

Injury. 2024 Jun;55 Suppl 1:111477. doi: 10.1016/j.injury.2024.111477. Epub 2024 Jul 26.

DOI:10.1016/j.injury.2024.111477

PMID:39069345

Abstract

INTRODUCTION

Treatment options for open tibial shaft fractures include external fixation with or without early conversion to internal fixation.

OBJECTIVES

The aim of this study was to describe 1) early conversion to internal fixation and definitive external fixation and 2) in case of conversion, to identify risk factors for complications.

METHODS

Seventy-two external fixations of open fractures of the tibial shaft (Gustilo classification, 7 fractures (9.7 %) grade I, 25 fractures (34.7 %) grade II, 40 fractures (55.6 %) grade III (31 grade IIIA and 9 grade IIIB)) were included in a continuous non-randomised study. Thirty-three fractures without infection signs were converted to internal fixation at a mean time of 40.5 +/-15 days (IF group). External fixation was maintened in the remaining 39 fractures (EF group).

RESULTS

In the "IF" group, the union rate was 69.7 % at 6.3 +/-3.6 months (3-16). All patients had complete union at 16 months, requiring 2.8 +/-0.8 reoperations. Fixation with external fixation only ("EF" group) showed a union rate of 51.3 % at 8.9 +/-4 (5-22) months and 96 % at 16 months after 3.7 +/-0.9 reoperations. Superficial infection (12.1 %; p = 0.011) and numerous surgeries (2.76; p = 0.004) were found to be risk factors for deep infection. Time to wound closure >7 days (p = 0.049), time to reoperation >28 days (p = 0.00), numerous surgeries (2.76; p = 0.004) and deep infection (6.1 %; p = 0.027) were found to be union failure factors.

CONCLUSION

Early conversion of external fixation to internal fixation is an effective option to achieve bone union of open tibial fractures in selected patients.

摘要

简介

开放性胫骨骨干骨折的治疗选择包括外固定加或不加早期改为内固定。

目的

本研究旨在描述 1）早期改为内固定和确定性外固定，2）在改为内固定的情况下，确定并发症的危险因素。

方法

72 例开放性胫骨骨折（Gustilo 分类，7 例（9.7%）为 I 级，25 例（34.7%）为 II 级，40 例（55.6%）为 III 级（31 例为 IIIA，9 例为 IIIB））的外固定被纳入一项连续的非随机研究。33 例无感染迹象的骨折在平均 40.5+/-15 天（IF 组）时改为内固定。39 例骨折继续维持外固定（EF 组）。

结果

在“IF”组中，6.3+/-3.6 个月（3-16 个月）时的愈合率为 69.7%。所有患者在 16 个月时均完全愈合，需要 2.8+/-0.8 次再手术。仅用外固定（“EF”组）的愈合率为 8.9+/-4（5-22）个月时为 51.3%，16 个月时为 96%，需要 3.7+/-0.9 次再手术。浅表感染（12.1%；p=0.011）和多次手术（2.76；p=0.004）被认为是深部感染的危险因素。伤口闭合时间>7 天（p=0.049）、再手术时间>28 天（p=0.00）、多次手术（2.76；p=0.004）和深部感染（6.1%；p=0.027）被认为是愈合失败的因素。