中国修复重建外科杂志

中国修复重建外科杂志

Taylor 空间支架治疗胫腓骨中下段骨折疗效观察

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目的 探讨应用 Taylor 空间支架治疗胫腓骨中下段骨折的临床疗效和安全性。 方法 回顾分析 2015 年 1 月—2017 年 1 月收治的 74 例胫腓骨中下段骨折患者临床资料,根据骨折固定方法不同分为内固定组(26 例)和外固定组(48 例)。两组患者年龄、性别、致伤原因、骨折类型、受伤至手术时间等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。记录并比较两组患者术中出血量、骨折愈合时间、固定物去除时间及并发症发生情况;采用 Johner-Wruhs 胫骨干骨折治疗最终效果评价标准评定患肢功能;采用罗从风等的标准评定术后下肢力线恢复情况。 结果 两组患者均获随访,随访时间 6~22 个月,中位时间 14 个月。患者骨折均获愈合,内固定组术中出血量、骨折愈合时间及固定物去除时间均显著高于外固定组,差异有统计学意义(P<0.05)。术后内固定组发生钢板外露 1 例、骨折延迟愈合 1 例、钢板断裂 1 例;外固定组发生骨折延迟愈合 2 例、软组织缺损 4 例;两组并发症发生率比较差异无统计学意义(χ2=0.015,P=0.904)。术后 10 个月参照 Johner-Wruhs 标准评定患肢功能,内固定组优 19 例,良 5 例,可 2 例,优良率 92.3%;外固定组优 42 例,良 3 例,可 2 例,优良率 95.7%;两组优良率比较差异无统计学意义(χ2=0.392,P=0.531)。术后 4 个月采用罗从风等的标准评定术后下肢力线恢复情况,内固定组优 24 例,可 1 例,差 1 例,优良率 92.3%;外固定组优 46 例,可 1 例,差 1 例,优良率 95.8%;两组优良率比较差异无统计学意义(χ2=0.520,P=0.471)。 结论 采用 Taylor 空间支架治疗胫腓骨中下段骨折相较于采用钢板内固定治疗愈合时间短,并发症少,可减少骨折治疗周期,有利于患者骨折愈合及肢体功能恢复,相对安全可靠。

Objective To determine the effectiveness and the safety of the Taylor spatial frame in treatment of intermediate or distal tibiofibula fractures. Methods The clinical data of 74 patients with intermediate or distal tibiofibular fractures treated between January 2015 and January 2017 were retrospectively analyzed. According to fixation methods, they were divided into internal fixation group (26 cases) and external fixation group (48 cases). There was no significant difference in the age, gender, cause of injury, type of fracture, time from injury to operation between 2 groups (P>0.05). The intraoperative blood loss, fracture healing time, fixator removal time, and complications were recorded and compared. The final function evaluation criteria of Johner-Wruhs humeral shaft fracture were used to evaluate the function of the affected limb. The lower limb force line recovery after operation was evaluated according to the standard evaluation of LUO Congfenget al. Results Both groups were followed up 6-22 months (median, 14 months). All patients obtained the fracture healing. The intraoperative blood loss, fracture healing time, and fixator removal time were significantly higher in the internal fixation group than those in the external fixation group (P<0.05). There were 1 case of plate exposure, 1 case of delayed fracture healing, and 1 case of plate fracture in the internal fixation group; and there were 2 cases of delayed fracture healing and 4 cases of soft tissue defect in the external fixation group; no significant difference was found in the incidence of complications between 2 groups (χ2=0.015, P=0.904). The function of the affected limb was evaluated by Johner-Wruhs standard at 10 months after operation, the results was excellent in 19 cases, good in 5 cases, and fair in 2 cases in the internal fixation group, with an excellent and good rate of 92.3%; the results was excellent in 42 cases, good in 3 cases, and fair in 2 cases in the external fixation group, with an excellent and good rate of 95.7%; showing no significant difference between 2 groups (χ2=0.392, P=0.531). The lower limb force line recovery after operation was evaluated according to the standard evaluation of LUO Congfeng et al.at 4 months after operation, the results was excellent in 24 cases, fair in 1 case, poor in 1 case in the internal fixation group, with an excellent and good rate of 92.3%; the results was excellent in 46 cases, fair in 1 case, poor in 1 case in the external fixation group, with an excellent and good rate of 95.8%; showing no significant difference between 2 groups (χ2=0.520, P=0.471). Conclusion The use of Taylor spatial frame in the treatment of the intermediate or distal tibiofibular fractures can obviously reduce the healing time and complications than the internal fixation of the plate. It can reduce the fracture treatment cycle and is beneficial to the fracture healing and limb function recovery, which is relatively safe and reliable.

关键词: 胫腓骨骨折; Taylor空间支架; 闭合复位; 力线矫正

Key words: Tibiofibula fractures; Taylor spatial frame; closed reduction; corrective force line

引用本文: 张宁宁, 万春友, 张涛, 马继海, 刘钊, 王明杰, 葛启航. Taylor 空间支架治疗胫腓骨中下段骨折疗效观察. 中国修复重建外科杂志, 2018, 32(8): 1012-1017. doi: 10.7507/1002-1892.201712095 复制

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