Ivanovski A, Pejak V
Odeljenje za hirurske bolesti-Odsek za ortopediju, Vojnomedicinski centar, Novi Sad.
Med Pregl. 1998 May-Jun;51(5-6):259-63.
Problems, consequences and influence of immobilization on tissue and fracture healing, as well as patient's psyche and entire condition of the organism, are well known. With immobilisation patient looses a part of extremity movement. Healing of fractures and remaining tissues is a natural process, so it is usually said that fractures and tissues heal not because of immobilization, but in spite of it. The theory of treating by functional cast (PTB-patellar tendon bearing), firstly described by Sarmiento, is based on tissues natural capability to heal and on its functional guiding to the final cause. The aim of this study is to analyze our previous expirience in regard to this method.
We have studied patients from 7 to 70 years of age with fracture of one or both lower leg bones. After injury, patients were mobilized using upper leg plaster impregned bandages applied to two thirds of extremity's circumference. After X-ray control and locating the position of broken parts, patients were released with thromboprophylaxis using Acetilsalycil acid (Midol) 3 x 1 tablet per day. In some cases, where reduction of broken fragment was hard, total anesthesia was performed. In cases of oblique and spiral fractures, because of possible redislocation we have waited with application of lower leg functional cast up to 3 weeks.
We have studied 59 patients, most of them between the age of 11 and 20. In most cases functional cast was applied after 21 to 30 days, fractures healed after 90 to 99 days and the shortening of extremities was clinically non measureable. Usually it was 24 mm.
Treatment of lower leg fractures is not simple. We especially point to problems with circulation and skin which have to be controlled over and over. There are reports of rejecting operational method as a method for lower leg fracture treating. Our results are the same as those achieved by other authors. Reposition of bone fragments must be performed with special attention. It is best if it is performed during total anesthesia, because muscles are relaxed and therefore circulation gets better, intensity of pain decreases and there are no skin necroses. In few cases, at the beginning of treatment there were skin blisters which only lengthened the treatment. These problems were prevented by early reposition, retention of bone parts and elevation of extremities.
Lower leg functional cast gives excellent results in treating diaphyseal lower leg fractures. Early mobilization positively influences the patient's psyche and enables quick resocialization. Physical treatment is usually not necessary.
固定对组织和骨折愈合的问题、后果及影响，以及对患者心理和机体整体状况的影响，都是众所周知的。通过固定，患者会失去部分肢体活动能力。骨折和其余组织的愈合是一个自然过程，所以通常说骨折和组织的愈合并非因为固定，而是尽管有固定仍能愈合。萨尔米恩托首次描述的功能性石膏（PTB - 髌腱承重）治疗理论，是基于组织自然的愈合能力及其对最终结果的功能导向。本研究的目的是分析我们此前关于此方法的经验。
我们研究了年龄在7岁至70岁之间的单侧或双侧小腿骨骨折患者。受伤后，使用浸渍石膏的大腿绷带对患者进行固定，绷带环绕肢体周长的三分之二。经X线检查并确定骨折部位后，给予患者阿司匹林（米多）进行血栓预防，每天3次，每次1片。在某些骨折碎片复位困难的情况下，进行全身麻醉。对于斜形和螺旋形骨折，由于可能出现再移位，我们等待3周后才应用小腿功能性石膏。
我们研究了59例患者，其中大多数年龄在11岁至20岁之间。大多数情况下，在21天至30天后应用功能性石膏，骨折在90天至99天后愈合，肢体缩短在临床上无法测量，通常为24毫米。
小腿骨折的治疗并不简单。我们特别指出必须反复控制循环和皮肤方面的问题。有报道称不采用手术方法治疗小腿骨折。我们的结果与其他作者的结果相同。骨折碎片的复位必须格外小心。最好在全身麻醉下进行，因为此时肌肉放松，循环改善，疼痛强度降低，且不会出现皮肤坏死。在少数情况下，治疗开始时出现皮肤水泡，这只会延长治疗时间。通过早期复位、固定骨折部位和抬高肢体可预防这些问题。
小腿功能性石膏在治疗胫骨干骨折方面效果极佳。早期活动对患者心理有积极影响，并能使其迅速重新融入社会。通常无需进行物理治疗。
