腓骨穿针内固定联合孟氏架外固定治疗胫腓骨骨折的临床研究  

A clinical study of fibular Kirschner wire internal fixation combined with Meng’s fixator external fixation for treatment of tibiofibular fractures

作　　者：李国梁[1] 王旭洋[1] 赵建勇[1] 张亮 于君君 韩广普[1] LI Guoliang;WANG Xuyang;ZHAO Jianyong;ZHANG Liang;YU Junjun;HAN Guangpu(Cangzhou Hospital of Integrated TCM-WM·Hebei,Cangzhou 061001,Hebei,China)

机构地区：[1]河北省沧州中西医结合医院,河北沧州061001

出　　处：《中医正骨》2021年第4期22-27,共6页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:探讨腓骨穿针内固定联合孟氏架外固定治疗胫腓骨骨折的临床疗效和安全性。方法:将102例胫腓骨骨折患者随机分为2组,每组51例,分别采用单纯孟氏架外固定和腓骨穿针内固定联合孟氏架外固定治疗。记录并比较2组患者的手术时间、术中出血量、术后下床时间、住院时间、骨折愈合时间、Fugl-meyer下肢运动功能评分、美国足与踝关节协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足功能评分、综合疗效和并发症发生情况。结果:①一般指标。联合固定组患者的手术时间长于孟氏架外固定组[(129.38±19.23)min,(108.35±15.57)min,t=6.070,P=0.000]、术中出血量多于孟氏架外固定组[(198.68±25.13)mL,(169.12±24.09)mL,t=6.064,P=0.000],术后下地时间、住院时间、骨折愈合时间均短于孟氏架外固定组[(15.91±5.98)d,(19.81±5.57)d,t=3.408,P=0.001;(20.67±6.17)d,(24.71±6.98)d,t=3.097,P=0.003;(61.81±5.57)d,(69.12±5.76)d,t=6.515,P=0.001]。②Fugl-meyer下肢运动功能评分。术前2组患者Fugl-meyer下肢运动功能评分比较,差异无统计学意义[(9.98±3.75)分,(9.19±3.54)分,t=13.392,P=0.410];术后6个月,联合固定组患者的Fugl-meyer下肢运动功能评分高于孟氏架外固定组[(27.36±4.96)分,(24.12±4.76)分,t=9.013,P=0.011],2组患者Fugl-meyer下肢运动功能评分均高于术前(t=19.961,P=0.000;t=17.973,P=0.000)。③AOFAS踝与后足功能评分。术前2组患者AOFAS踝与后足功能评分比较,差异无统计学意义[(51.28±5.59)分,(50.64±5.26)分,t=10.437,P=0.641];术后6个月,联合固定组患者的AOFAS踝与后足功能评分高于孟氏架外固定组[(84.82±7.92)分,(80.05±7.76)分,t=7.481,P=0.027],2组患者AOFAS踝与后足功能评分均高于术前(t=24.708,P=0.000;t=22.404,P=0.000)。④综合疗效。术后6个月,2组患者的综合疗效比较,差异无统计学意义(Z=-1.820,P=0.069)。⑤并发症。孟氏架外固定组术后出现切口感染3例、下肢深静脉Objective:To explore the clinical curative effects and safety of fibular Kirschner wire(K-wire)internal fixation combined with Meng’s fixator external fixation for treatment of tibiofibular fractures.Methods:One hundred and two patients with tibiofibular frac-tures were randomly divided into 2 groups,51 cases in each group,and were treated with monotherapy of Meng’s fixator external fixation(monotherapy group)and combination therapy of fibular K-wire internal fixation and Meng’s fixator external fixation(combination therapy group)respectively.The operative time,intraoperative blood loss,bed rest time,hospital stays,fracture healing time,Fugl-meyer(FM)low-er extremity motor subscores,American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot function scores,total clinical curative effects and complication incidence were recorded and compared between the 2 groups respectively.Results:The operative time was longer,the intraoperative blood loss was more and the bed rest time,hospital stays and fracture healing time were shorter in combination therapy group compared to monotherapy group(129.38±19.23 vs 108.35±15.57 minutes,t=6.070,P=0.000;198.68±25.13 vs 169.12±24.09 mL,t=6.064,P=0.000;15.91±5.98 vs 19.81±5.57 days,t=3.408,P=0.001;20.67±6.17 vs 24.71±6.98 days,t=3.097,P=0.003;61.81±5.57 vs 69.12±5.76 days,t=6.515,P=0.001).There was no statistical difference in FM lower extremity motor subscores between the 2 groups before the surgery(9.98±3.75 vs 9.19±3.54 points,t=13.392,P=0.410).The FM lower ex-tremity motor subscores were higher in combination therapy group compared to monotherapy group at 6 months after the surgery(27.36±4.96 vs 24.12±4.76 points,t=9.013,P=0.011),and were higher at 6 months after the surgery compared to pre-surgery in the 2 groups(t=19.961,P=0.000;t=17.973,P=0.000).There was no statistical difference in AOFAS ankle-hindfoot function scores be-tween the 2 groups before the surgery(51.28±5.59 vs 50.64±5.26 points,t=10.437,P=0.641).The AOFAS ankle-hindfoot function scores w

关 键 词：胫骨骨折 腓骨 骨折固定术 内 外固定器 临床试验 

分 类 号：R687.3[医药卫生—骨科学]