八、关节功能障碍
近关节及经越肌肉的穿针，可不同程度地影响穿针平面以下的关节功能活动而致关节僵硬。术中、术后应注意以下问题：
1.穿针时关节位置 穿针时必须置上下关节于中立位或功能位。股骨穿针时置膝关节于屈曲90°～130°位。
2.正确选择进针点 小腿中段尽可能不穿全针，于前内侧穿半针。踝上及胫骨结节处穿全针，其他部位虽无法避免不穿越肌肉，但穿针点应尽可能选择在肌间隙。
3.术后尽早进行被动与主动功能锻炼下肢要尽早负重行走，上肢应尽可能行生活自理。若软组织损伤严重，早期可应用托板等支具维持关节功能位，待软组织损伤修复后再行被动、主动功能锻炼。固定时间过长可发生关节僵硬。
4.骨折愈合后及时拆除外固定器 固定时间过长影响关节活动。
总之，严格操作技术操作与细心护理可避免上述大部分并发症的发生。但操作技术本身还需不断提高与完善。在应用外固定器过程中，应及时发现问题，采取有效措施防止并发症发生。
（鲁玉来 夏和桃 杨华清）
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