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严重下肢开放性骨折常伴有骨缺损，软组织缺损及血管损伤，极大危及肢体安全，故保肢治疗是创伤骨科的棘手问题。目前国内缺乏专业的区域救治体系，存在清创时机与清创医师资质不明确、软组织覆盖不及时等问题，导致绝大多数患者无法获得满意的肢体功能恢复。骨整形是由英国骨科医师学会等组织提出的治疗下肢开放性骨折的新方法，具有手术次数少、骨愈合快、感染等并发症发生率低、肢体功能恢复佳等优势，为严重下肢开放性骨折的治疗带来了新的方向。笔者主要分析目前严重下肢开放性骨折治疗存在的问题，并介绍骨整形治疗的新理念，加深创伤骨科医师对严重下肢开放性骨折治疗的认识，为提高严重下肢开放性骨折的治疗效果提供参考。“,”Severe open fractures of the lower limb are often accompanied by bone defect, soft tissue defect and vascular injury, which greatly endangers safety of the lower limb. Limb salvage treatment is a difficult problem in orthopedic trauma. Now the main problems of limb salvage treatment in China are the lack of professional regional treatment system, ambiguity in the timing of debridement and the qualification of debridement doctor and delayed soft tissue coverage. As a result, the majority of patients cannot achieve satisfactory recovery of limb function. The concept of Orthoplastics was first advocated in the publication of guidelines for the treatment of open fractures in lower limbs by British Orthopaedic Association. There are significant advantages of Orthoplastic strategies, such as less frequency of operation, less healing time of the fracture, lower infection rate and other complications. This strategy brings us new direction for the treatment of severe open fractures of the lower limb. The authors mainly analyze the problems in treatment of severe open fractures of the lower limb, introduce the new concept of orthoplastics, improve the understanding of treatment of severe open fractures of the lower limb in Orthopaedic surgeons, so as to provide references for improving the treatment effect.