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目的探讨HoffmannⅡ组合式外固定系统治疗儿童胫腓骨开放性不稳定性骨折的疗效。方法对12例儿童开放性胫腓骨不稳定性骨折,进行外固定支架治疗,观察骨折临床愈合时间及有无并发症发生。彻底清创后根据原有伤口的特点选择手术切口扩创。骨折复位后用可吸收线捆绑游离的骨折块,在胫骨钻入3根以上外固定针,针的位置不追求对称,尽可能地使杆-杆固定夹朝向骨折方向,连接杆也尽可能地短。C臂X线机透视下检查骨折复位情况。放置负压引流管或橡皮片,如肢体肿胀严重,可用VSD覆盖创面,二期闭合伤口。结果本组随访时间14-38个月,平均26个月。骨折骨生愈合及拆除外固定架时间5.0-6.5个月,平均5.2个月。拆除外固定系统时膝、踝关节功能基本恢复正常,骨折对位对线良好,骨折全部骨性愈合,无再次骨折的病例。3例出现针道感染,其中1级2例、2级1例,通过换药、抗生素治疗、加强护理等手段痊愈,无因针道感染发生外固定系统松动而提前拆除。按照Jchner-Wruh胫骨骨折疗效评定标准,本组优良率为95%。结论彻底清创可以最大限度地减少感染源和后期的感染控制呈正相关。儿童开放性胫腓骨不稳定性骨折采用HoffmannⅡ组合式外固定系统具有创伤小、固定牢靠和并发症少等优点,是治疗儿童开放性胫腓骨骨干不稳定性骨折理想的治疗方法 。
Objective To investigate the curative effect of HoffmannⅡ combined external fixation system in the treatment of unstable tibiofibular fractures in children. Methods Twelve children with open tibiofibular instability fractures were treated with external fixation. The clinical healing time and the occurrence of complications were observed. After complete debridement according to the characteristics of the original choice of surgical wound incision. Fracture reduction with absorbable line bundled free fragments, drilling in the tibia more than three external fixation needle, the needle position is not the pursuit of symmetry, as far as possible so that the rod - rod fixation towards fracture direction, the connecting rod as much as possible short. C-arm X-ray examination under the perspective of fracture reduction. Place negative pressure drainage tube or rubber sheet, such as severe swelling of the limbs, VSD can cover the wound, the second closed wound. Results This group was followed up for 14-38 months with an average of 26 months. Fracture bone healing and removal of external fixators 5.0-6.5 months, an average of 5.2 months. Removal of external fixation system, knee, ankle function returned to normal, good alignment of the fracture line, the fracture of all bony union, no further fracture cases. In 3 cases, needle infection occurred. Among them, grade 1 was in 2 cases and grade 2 in 1 case. He was cured by dressing change, antibiotic treatment and intensive nursing. There was no premature removal of external fixation system due to needle-needle infection. According to Jchner-Wruh tibial fracture evaluation standards, the excellent rate of 95%. Conclusions Thorough debridement can minimize the source of infection and post-infection infection control. Open fractures of tibia and fibula with open fractures Hoffmann Ⅱ combined with external fixation system has the advantages of less trauma, firm fixation and less complications, which is an ideal treatment for open tibia and fibula unstable fractures in children.