Objective To compare the efficacy of staged management with early stage internal fixation in patients with high-energy extremity fractures. Methods Forty-nine patients with high-energy fractures were included in the study, including 21 cases treated with staged management and 28 cases treated with internal fixations in the early stage. Al patients were fol-lowed up and related functions were evaluated. Results Patients in staged management were fol owed up for 16.0±2.3 months, all patients obtained bone union without infection with the satisfactory rate of 71.4%. The overall complication rate was 4.8%, in-cluding one patient with skin necrosis. Patients with early internal fixation were fol owed up for 15.0±1.3 months and 60.7%pa-tients obtained satisfactory results. The complication rate was 32.1% in this group of patients; there were 4 patients with skin necrosis, one patients with bone unhealed,3 patients with infection and 1 patient died. There were significant differences in com-plication rate between two groups (P<0.05). Conclusion Staged management is an effective surgical approach in treatment of high-energy extremity fractures with satisfactory results and less complications.% 目的探讨四肢高能量粉碎性骨折分期治疗的疗效及处理要点.方法对收治的49例四肢高能量粉碎性骨折患者,21例行分期治疗,28例行一期内固定治疗,术后随访时按相关功能评分进行疗效评价并比较.结果分期治疗组获得随访(16.0±2.3)个月,所有患者均获得骨性愈合,疗效优8例,良7例,优良率71.4%,仅发生皮肤坏死1例,并发症发生率4.8%.一期内固定组获得随访(15.0±1.3)个月,疗效优7例,良10例,优良率60.7%,发生皮肤坏死4例,死亡1例,骨不愈1例,创口感染3例(保守治疗难以控制改外固定支架外固定,畸形愈合),并发症发生率32.1%.分期治疗组疗效优良率略高于一期内固定组,而并发症发生率明显低于一期内固定组(P<0.05).结论分期治疗四肢高能量粉碎性骨折的临床效果确切,外固定支架固定转换时机应个体化,并须重视关节内骨折的处理及骨质缺损植骨方式和时机的选择.
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