汶川地震中踝关节创伤治疗的回顾性分析
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摘要
目的:总结2008年5月12日四川汶川地震中,华西医院救治的踝关节损伤病员的临床特点和治疗经验。方法:回顾性分析2008年5月12日至2008年6月9日四川大学华西医院救治的103例踝关节创伤患者的临床资料。其中资料完整的97例,男59例,女38例,年龄14-76岁,平均34.9岁。根据受伤时的情况(软组织损伤和踝关节骨折)将软组织损伤和骨折类型及治疗的措施与治疗结果进行分析。结果:在我院住院期间,共计46例骨折患者行切开复位内固定,16例行外固定架固定,扩创17例,植皮25人次;根据术后X片和关节功能恢复情况评定疗效,局部功能评定按Leeds描述的标准,治疗结果分为优、良、差3级,其中优51例,良32例,差14例,优良率86.6%。至2008年6月9日仅有7例伤口创面未闭合,3例外固定治疗的粉碎性骨折尚需进一步手术治疗,1例因为感染和肌肉坏死行截肢术;其他伤员骨折复位固定满意;无一例患者因为踝关节损伤而死亡;无一例内固定并发症发生;无一例院内感染发生。结论:我院对地震踝关节损伤的伤员的治疗并发症少,疗效良好。
Objective: To summary the clinic characters and therapies experience of ankle joint injuries in the wounded patients of West China hospital of sichuan University,who were injured in the Wenchuan earthquake.Methods: We collected and analysed retrospectively 103 wounded patients with ankle joint injuries,who were remedied in West China hospital from May 5th to June 9th in 2008.Finally,59 men and 38 women,mean aged 34.9 years(from 14 to 76 years old) with the complete data entered the analysis.According to the wounded situation(the soft tissue injury and the fractures),soft tissue injury condition,fractures classification,treatment measures and the results were analyzed.Results: 46 fractured patients underwent open reduction and internal fixation,another 16 patients undertook the external fixation.17 patients needed to debride,and the dermatoplasty were underwent 25 man-time.Up to June 9th,2008,there were only seven cases of wound not close-up,3 cases of comminuted fracture treated by external fixation requiring further surgery,one cases of amputation because of infection.Others fractures were treated by reduction and fixation with satisfactory result;none of the patients die because of ankle injury,no case with fixation complications or hospital onset of infection(HOI).Conclusion: There were less complication and good outcome to patients with ankle injury in the earthquake by Debride,external fixation,and open reduction and internal fixation according to the the wounded situation and severity.
Objective: To summary the clinic characters and therapies experience of ankle joint injuries in the wounded patients of West China hospital of sichuan University,who were injured in the Wenchuan earthquake.Methods: We collected and analysed retrospectively 103 wounded patients with ankle joint injuries,who were remedied in West China hospital from May 5th to June 9th in 2008.Finally,59 men and 38 women,mean aged 34.9 years(from 14 to 76 years old) with the complete data entered the analysis.According to the wounded situation(the soft tissue injury and the fractures),soft tissue injury condition,fractures classification,treatment measures and the results were analyzed.Results: 46 fractured patients underwent open reduction and internal fixation,another 16 patients undertook the external fixation.17 patients needed to debride,and the dermatoplasty were underwent 25 man-time.Up to June 9th,2008,there were only seven cases of wound not close-up,3 cases of comminuted fracture treated by external fixation requiring further surgery,one cases of amputation because of infection.Others fractures were treated by reduction and fixation with satisfactory result;none of the patients die because of ankle injury,no case with fixation complications or hospital onset of infection(HOI).Conclusion: There were less complication and good outcome to patients with ankle injury in the earthquake by Debride,external fixation,and open reduction and internal fixation according to the the wounded situation and severity.
引文
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[13]BENCA J,KALAVSKY E,MIKLOSKO J,et al.Infectious dis-eases in disaster areas/catastrophes[J].Neuro EndocrinolLett,2007,28,Suppl2:40-43.
[14]王爱民,吴选道.长骨干开放性骨折伤口感染原因分析.骨与关节损伤杂志,1992,3:173.
[15]BRATZLER D W,HOUCK P M,RICHARDS C,et al.Use ofantimicrobial prophylaxis for major surgery:baseline from the na-tional surgical infection prevention project.Arch Surg,2005,140:174-182.
[16]HOINESS P,STROMSOE K.The influence of the timing of sur-gery on soft tissue complications and hospital stay:a review of 84closed ankle fractures[J].Ann Chir Gynaecol,2000,89(1):629.
[17]BAR DAYAN Y,LEIBA A,BEARD P,et al.A multidisciplinar-y field hosp ital as a substitute for medical hosp ital care in the af-termath of an earthquake:the experience of the Israeli DefenseForces Field Hosp ital in Duzce,Turkey,1999[J].Prehosp Di-sasterMed,2005,20(2):103-106.
[2]SULTAN S,SHAH A A.Management of open tibial fractures atAyub Teaching Hospital,Abbottabad.J Ayub Med CollAbbotta-bad,2001,13:22-23.
[3]SIEGEL I’TORNE~A P 3RD.Extraperiosteal plating of prona-tion—abduction ankle fractures.J Bone Joint Surg(Am),2007,89(2):276-281.
[4]GRENSHAW A H.Campell’s operative orthopaedics[J].Louis,1992,785(2):895.
[5]KATIOZ H,BOMBACI H,GO RGEC M.Treatment of trimalle-olar fractures.Is osteosynthesis needed in posterio rmalleolar frac-tures measuring less than 25%of the joint surface?[J].Acta Or-thop Traumatol Turc,2003,37(4):299-303.
[6]LERNER A,STEINH.Hybrid thin wire external fixation:an ef-fective,minimally invasive,modular surgical tool forth estabiliza-tion of periarticular fractures[J].Orthopedics,2004,27(1):59-62.
[7]EGOL K A,WEISZ R,HIEBERT R,et al.Does fibular platingimprove alignment after intramedullary nailing of distal metaphy-seal tibia fractures?J Orthop Trauma,2006,20(2):94-103.
[8]TORNETTA P 3RD.Competence of the deltoid 1igment in bimal-leolar ankle fractures after medial malleoar fixatoin.Bone JointSurg(Am),2000,82(6):843-848.
[9]IM G I,TAE S K.Distal metaphyseal fractures of tibia:a prospec-tive randomized trial of closed reduction and intramedullary nailversus open reduction and plate and screws fixation.J Trauma,2005,59(5):l219-1223.
[10]Rose J D,Flanigan K P,Mlodzienski A.Tibiofibular diastasiswithout ankle fracture:a review an d report of two cases.J FotAnkle Surg,2002,4l(1):44-51.
[11]JOUKAINEN A,PARTIO E K,WARIS P,et al.Bioabsorbablescrew fixation for the treatment of ankle fractures.J Orthop Sci,2007,l2(1):28-34.
[12]CAUDLE R J,STERN P J.Severe open fractures of t he tibia[J].J Bone Joint Surg Am,1987,69(6):801-807.
[13]BENCA J,KALAVSKY E,MIKLOSKO J,et al.Infectious dis-eases in disaster areas/catastrophes[J].Neuro EndocrinolLett,2007,28,Suppl2:40-43.
[14]王爱民,吴选道.长骨干开放性骨折伤口感染原因分析.骨与关节损伤杂志,1992,3:173.
[15]BRATZLER D W,HOUCK P M,RICHARDS C,et al.Use ofantimicrobial prophylaxis for major surgery:baseline from the na-tional surgical infection prevention project.Arch Surg,2005,140:174-182.
[16]HOINESS P,STROMSOE K.The influence of the timing of sur-gery on soft tissue complications and hospital stay:a review of 84closed ankle fractures[J].Ann Chir Gynaecol,2000,89(1):629.
[17]BAR DAYAN Y,LEIBA A,BEARD P,et al.A multidisciplinar-y field hosp ital as a substitute for medical hosp ital care in the af-termath of an earthquake:the experience of the Israeli DefenseForces Field Hosp ital in Duzce,Turkey,1999[J].Prehosp Di-sasterMed,2005,20(2):103-106.
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