Evaluate Of Clinical Curative Effect Of Primary And Extende Treatment For Gustiloâ…¢B,â…¢C Type Bottom Leg Damage

Objective:With continuous development of transportation and industrialization, the number of patients with traumatic fracture was significantly increased. Tibia is the most common area of long bone fracture. As anatomical factors of leg bottom, high energy trauma could lead to the fracture and serious injury of skin, nerves, blood vessels and tendon. Bone, nerve, blood vessels and tendons exposed directly outside since it is difficult to close the wound after fixation.If damaged soft tissue and the wound were not repaired promptly, it often led to not heal fracture, osteomyelitis, necrosis of nerve, blood vessel and tendon, large impact or amputation on joint function. Therefore, it is important to repair the skin and soft tissue for the Leg bottom's GustiloⅢB-type andⅢC-type injured. The analysis is to understand the characteristics of the bottom leg's GustiloⅢB andⅢC-type injured and explore the different time of repairment's effect on the follow-up clinical treatment and physical function.Method:150 male patients of total hospital of jincheng coal company in shanxi were surveyed from January of 2003 to December of 2008.Patients were divided into two groups:Ⅰgroup (repaired during phaseⅠ) andⅡgroup (repaired during extended phase)based on medical records and the time of repairement.Ⅰgroup had 81 cases with 69 cases inⅡgroup.All of patients were in general anesthesia or spinal anesthesia.The wound were debrided.Fracture were fixed. Tendons, nerves, blood vessels were repaired. The wound were closed with free flaps。Anti-infection were done after operation. The rate of infection, the information of healing after 6 months, ankle function, amputation and so on between two groups were compared after clinical observation and treatment.Results:Infection rate of groupⅠwas 13.58%(11 cases) and that of groupⅡwas 27.54%(19 cases). Infection rate between two groups were different significantly (x2=4.536, P=0.033<0.05). The rate of groupⅠwas lower than that of groupⅡ.Amputation rate of groupⅠwas 6.17%(5 cases) and that of groupⅡwas 17.39%(12 cases). Amputation rate between two groups were different significantly (x2=4.667, P=0.031<0.05). The rate of groupⅠwas lower than that of groupⅡ.Ankle Joint's Mazur Score:Fineness rate of groupⅠwas 71.60%(58 cases) and that of groupⅡwas 47.83%(33 cases). Fineness rate between two groups were different significantly (x2=8.829,P=0.003<0.05). The rate of groupⅠwas higher than that of groupⅡ.The information of healing after 6 months:Healing rate of groupⅠwas 72.84%(59 cases) and that of groupⅡwas 42.03%(29 cases). Healing rate between two groups were different significantly (x2=14.586, P<0.001). The rate of groupⅠwas higher than that of groupⅡ.Conclusion:The infection rate and amputation rate of patients who were repaired in phaseⅠwere low. The healing rate after 6 months,the resluts of Mazur scores and fineness rate of ankle function among these patients were high.Clinical effect of Leg bottom's GustiloⅢB-type andⅢC-type injured were related with the phase of treatment but not related with the type.