背景:本研究旨在评估局部开发的外固定器(LDEF)作为象牙海岸开放性胫骨骨干骨折(OTDF)的确定性治疗方法的有效性。
方法:GustiloI,II,前瞻性纳入损伤后24小时内入院的患者和IIIAOTDF,并接受LDEF治疗。工会的比率,mal-union,败血症并发症,以及功能结果进行了评估,除了LDEF构造的完整性。评估了失败或不良结果的预测因素。
结果:总体而言,40名OTDF患者在受伤后24小时内入院。GustiloI,II,和IIIA骨折观察到三个,13和24名患者,分别。29例骨折愈合不畅,平均工会时间为8.47个月。在三起和四起案件中登记了马勒工会和非工会,分别。13例发生针迹感染(PTI),7例发生深部感染。除四名患者外,所有患者的感染都得到了解决,得了慢性骨髓炎.没有一个非工会与感染有关。32例患者的总体功能结果令人满意。PTI是慢性感染的唯一预测因素。双平面框架,当与单平面结构相比时,与显著改善的功能结果相关。
结论:LDEF显著改善了OTDF管理,因为它提供了更好的稳定性和优越的骨折愈合率比在相同的环境中观察到的标准护理。PTI仍然是一个基本问题,但是,希望,有限的负面后果。
BACKGROUND: This
study sought to evaluate the effectiveness of locally developed external fixators (LDEF) as definitive treatment for open tibia diaphyseal fractures (OTDF) in Ivory Coast.
METHODS: Gustilo I, II, and IIIA OTDFs of patients admitted within 24 hours of injury were prospectively included and treated with LDEF. The rates of union, mal-union, septic complications, as well as the functional results were assessed, in addition to the LDEF construct\'s integrity. Predictive factors of failure or poor results were assessed.
RESULTS: Overall, 40 OTDF patients were admitted within 24 hours of injury. Gustilo I, II, and IIIA fractures were observed in three, 13, and 24 patients, respectively. Uneventful fracture healing was obtained in 29 cases, with an average union time of 8.47 months. Mal-union and non-union were registered in three and four cases, respectively. Pin-track infection (PTI) was observed in 13 cases and deep infection in seven. Infection resolved in all patients except four, who developed chronic osteomyelitis. None of the non-unions were associated with an infection. The overall functional result was satisfactory in 32 patients. PTI was the only predictive factor for chronic infection. Biplanar frames, when compared to monoplanar constructs, were associated with a significantly improved functional outcome.
CONCLUSIONS: LDEF improved significantly the OTDF management, as it provided better stability and superior fracture healing rates than what is observed with the standard of care in the same environment. PTI remains an essential problem but with, hopefully, limited negative consequences.