中国修复重建外科杂志

中国修复重建外科杂志

Taylor 空间支架结合计算机辅助闭合复位在胫腓骨骨折中的应用研究

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目的探讨 Taylor 空间支架(Taylor spatial frame,TSF)治疗胫腓骨骨折中,术后应用计算机辅助闭合复位的临床疗效。方法回顾分析 2015 年 1 月—2017 年 9 月采用 TSF 治疗的 30 例胫腓骨骨折合并软组织损伤患者临床资料。根据复位方式不同分为对照组(15 例,TSF 外固定术中采用切开复位)和试验组(15 例,TSF 外固定术后 1~3 d 采用计算机辅助闭合复位)。两组患者性别、年龄、侧别、致伤原因、骨折 AO 分型、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。记录并比较两组手术时间、术中出血量、骨折愈合时间、拆除外固定架时间;拆除外固定架后 3 个月,参照 Johner-Wruhs 胫骨干骨折治疗最终效果评价标准评定患肢功能。结果两组患者均获随访,随访时间 9~16 个月,平均 14 个月。试验组手术时间、术中出血量、骨折愈合时间和拆除外固定架时间均显著小于对照组(P<0.05)。术后发生外固定架针道浅表感染 2 例(两组各 1 例),切口感染 1 例(对照组),骨折延迟愈合 1 例(对照组),创伤性关节炎 2 例(两组各 1 例);两组并发症发生率比较差异无统计学意义(χ2=0.370,P=0.543)。两组患者软组织缺损创面均Ⅰ期愈合。拆除外固定架 3 个月后,参照 Johner-Wruhs 胫骨干骨折治疗最终效果评价标准评定患肢功能,试验组优 3 例、良 9 例、可 2 例、差 1 例,优良率 80.0%;对照组优 3 例、良 8 例、可 3 例、差 1 例,优良率 73.3%;两组优良率比较差异无统计学意义(χ2=0.917,P=0.821)。结论与术中切开复位相比,TSF 治疗胫腓骨骨折术后采用计算机辅助闭合复位可缩短手术时间,减少术中出血量,降低长时间手术所致风险,减少骨折端血运破坏,缩短骨折愈合时间及戴架时长,减轻患者痛苦。

ObjectiveTo explore the effectiveness of Taylor spatial frame (TSF) in the treatment of tibiofibular fractures and computer-assisted closed reduction.MethodsThe clinical data of 30 cases of tibiofibular fractures with soft tissue injury treated with TSF between January 2015 and September 2017 was retrospectively analyzed. According to different reduction methods, the patients were divided into control group (15 cases, open reduction in TSF external fixation) and trial group (15 cases, closed reduction in 1-3 days after TSF external fixation). There was no significant difference in the general data such as gender, age, affected side, cause of injury, AO classification of fracture, time from injury to operation between the two groups (P>0.05). The operation time, intraoperative blood loss, fracture healing time, and removal time of external fixator were recorded and compared between the two groups. At 3 months after removal of external fixator, the limb function was evaluated according to Johner-Wruhs criteria for evaluating the final effect of tibial shaft fracture treatment.ResultsBoth groups were followed up 9-16 months, with an average of 14 months. The operation time, intraoperative blood loss, fracture healing time, and removal time of external fixator in the trial group were significantly shorter than those in the control group (P<0.05). There were 2 cases of superficial infection of the external fixation (1 case in each group), 1 case of incision infection (control group), 1 case of delayed fracture healing (control group), 2 cases of traumatic arthritis (1 case in each group); no significant difference was found in the incidence of complications between the two groups (χ2=0.370, P=0.543). The wounds of soft tissue defect healed by the first intension in both groups. At 3 months after removal of the external fixator, the limb function results in the trial group were excellent in 3 cases, good in 9 cases, fair in 2 cases, and poor in 1 case, and the excellent and good rate was 80.0%; in the control group, the results were excellent in 3 cases, good in 8 cases, fair in 3 cases, and poor in 1 case, and the excellent and good rate was 73.3%. There was no significant difference in incidence of complication between the two groups (χ2=0.917, P=0.821).ConclusionCompared with intraoperative open reduction, postoperative computer-aided closed reduction can shorten the operation time, reduce the intraoperative blood loss, reduce the risk of long-term operation, avoid to destroy the blood supply of fracture end, shorten the healing time of fracture and the wearing time of stent, and alleviate the pain of patients after TSF treatment of tibiofibular fracture.

关键词: 胫腓骨骨折; Taylor 空间支架; 计算机辅助闭合复位

Key words: Tibiofibular fractures; Taylor spatial frame; computer-aided closed reduction

引用本文: 葛启航, 万春友, 邵醒, 张涛, 贾鹏, 梅晓龙, 王明杰, 赵远航, 潘庆松, 马继海. Taylor 空间支架结合计算机辅助闭合复位在胫腓骨骨折中的应用研究. 中国修复重建外科杂志, 2019, 33(2): 144-148. doi: 10.7507/1002-1892.201807008 复制

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