Lortat-Jacob A, Guiziou B, Ramadier J O
Rev Chir Orthop Reparatrice Appar Mot. 1985;71(8):515-26.
The authors have treated 63 septic fractures of the tibia, 29 of whom were seen less than four months after the injury; the remainder were more long-standing. In both series the surgeon faced three problems--curing of the septic drainage, skin cover and bone union. In 46 cases bone excision was considered necessary: in 18 diaphyseal resection was performed. Immobilisation of the fracture was obtained by plaster cast in 14 cases, an external fixator in 48 cases, and medullary nailing in one. Reconstruction was needed in 11 cases after closed grafting, 9 of them being tibio-fibular, and in 46 after cancellous graft without skin closure. The results in 63 cases were 61 unions: 43 primary unions, 19 additional procedures to reinforce callus and 1 amputation. In two patients union remained particularly tenuous. Two patients are still showing discharge and 9 have poor skin cover. The average time to bone union was nine months and was twelve months in cases of resections greater than 3 cms. The authors are in favour of a technique of massive cancellous bone grafting of the tibia, aligned towards the fibula with partial skin closure. This procedure leads to a firmer and more rapid bone union than the Papineau technique. Secondary bone or skin procedures were needed less often. Tibio-fibular grafting was indicated in cases of limited infection and when the main tibial fragments were still uniting postero laterally.
作者治疗了63例胫骨感染性骨折，其中29例在受伤后不到4个月就诊；其余病例病程更长。在这两组病例中，外科医生都面临三个问题——感染引流的治愈、皮肤覆盖和骨愈合。46例患者被认为有必要进行骨切除：18例进行了骨干切除术。14例通过石膏固定骨折，48例采用外固定器，1例采用髓内钉固定。11例在闭合植骨后需要重建，其中9例为胫腓骨重建，46例在松质骨植骨后未进行皮肤闭合。63例患者的结果为61例愈合：43例一期愈合，19例需要额外的措施来加强骨痂，1例截肢。2例患者的愈合仍然特别脆弱。2例患者仍有分泌物，9例皮肤覆盖不良。骨愈合的平均时间为9个月，切除长度大于3厘米的病例为12个月。作者支持一种胫骨大块松质骨移植技术，向腓骨方向对齐并部分闭合皮肤。与帕皮诺技术相比，该手术能实现更牢固、更快的骨愈合。二次骨或皮肤手术的需求较少。在感染局限且主要胫骨骨折仍在后外侧愈合的情况下，建议进行胫腓骨移植。
