目的 探讨应用损伤控制骨科（damage control orthopaedics, DCO）理念对GustiloⅢ型胫腓骨 骨折的患者进行手术治疗并评估其临床疗效。 方法 2006-01至2010-12应用DCO救治56例GustiloⅢ型胫腓骨骨 折患者，其中ⅢA型骨折19例，ⅢB型骨折32例，ⅢC型骨折5例。所有患者先行抗休克治疗、彻底清创、外固定架复位固定骨 折，以及应用VSD覆盖创面。经ICU复苏后，如软组织情况好，尽早实行确定性手术。 结果 56例全部获得随访 ，随访时间12~27个月，平均16.8个月。骨折一期愈合53例（94.6%），延迟愈合3例（5.4%），无骨髓炎及骨不连等并发症。 患肢功能按照Johner-Wruhs疗效分析法，优26例，良24例，中4例，差2例，优良率89.3%。 结论 对GustiloⅢ 型胫腓骨骨折伴有失血性休克和伴有（或）不伴有颅脑、胸腹部损伤的患者应用DCO理论指导手术治疗，疗效满意。骨折早期 治疗强调外固定支架快速适当复位固定骨折，彻底清创及应用VSD覆盖创面。

Objective To discuss and analyze the clinical effect of damage control orthopaedics (DCO) in 56 patients with Gustilo type III fractures of tibia and fibula. Methods A retrospective analysis was made of the 56 patients who were admitted from January 2006 to December 2010 for Gustilo type Ⅲ fractures of tibia and fibula. There were 19 cases of type ⅢA, 32 cases of type ⅢB, and 5 cases of ⅢC. All the 56 cases were treated with anti-shock measures, followed by vacuum sealing drainage and external fixation of fractures thorough debridement in the first stage, resuscitation in the ICU in the second stage, and definite surgery if the parenchyma permitted in the third stage. Results All the 56 patients were followed up for 16.8 months on average (12-27 months). There were 3 cases (5.4%) of delayed healing and 53 cases (94.6%) of bone healing by first intention. No osteomyelitis, bone nonunion or further complications were observed. The scoring system Johner-Wruhs assessment of efficacy for treatment was used. The results were excellent in 26 cases, good in 24 cases, and poor in 6 cases. The excellent and good rate was 89.3%. Conclusions Application of DCO is effective for Gustilo type Ⅲ fractures of tibia and fibula with haemorrhagic shock and/or no craniocerebral injury, chest injury and abdomen injury. In the early treatment of such fracture, external fixation for fracture repair, thorough debridement and VSD covering wound surfaces should be emphasized.