Yaremchuk M J, Gan B S
Massachusetts General Hospital, Harvard Medical School, Boston MA 02114, USA.
Acta Orthop Belg. 1996;62 Suppl 1:188-92.
In this article, we have outlined our treatment approach to severe open tibial fractures (Gustilo type III injuries). We believe that collaboration between the plastic surgeons and orthopedic surgeons will aid in minimizing complications and facilitate optimal rehabilitation. In our opinion, the treatment of these injuries is facilitated in trauma centers with the expertise to address the complicated issues surrounding bone and soft tissue management techniques. The fundamental concepts of our approach are adequate debridement and early bone fixation, followed by soft tissue closure with obliteration of all dead space. Bone defects are addressed 4 to 8 weeks following injury with cancellous bone grafts or vascularized fibula transfer. This protocol has been successful in virtually eliminating the problem of infection and in salvaging and rehabilitating severely injured extremities.
在本文中，我们概述了对严重开放性胫骨骨折（ Gustilo III型损伤）的治疗方法。我们认为，整形外科医生和骨科医生之间的合作将有助于减少并发症并促进最佳康复。我们认为，在具备处理围绕骨和软组织管理技术的复杂问题专业知识的创伤中心，对这些损伤的治疗会更加顺利。我们治疗方法的基本理念是进行充分的清创和早期骨固定，随后进行软组织闭合并消除所有死腔。在受伤后4至8周，采用松质骨移植或带血管腓骨转移来处理骨缺损。该方案在几乎消除感染问题以及挽救和康复严重受伤的肢体方面取得了成功。
