带锁髓内钉固定、钢板螺钉固定和跟骨牵引加夹板固定治疗合并开放性胫腓骨骨折的多发性损伤患者效果分析  

Effects of Interlocking Intramedullary Nail Fixation,Plate and Screw Fixation,and Calcaneal Traction and Splint Fixation in Treatment of Patients with Multiple Injuries Complicated by Open Tibiofibular Fracture

作　　者：谢小飞 罗安玉[1] 黄琛 张军[1] 陈晨[1] 刘瀚霖[1] XIE Xiao-fei;LUO An-yu;HUANG Chen;ZHANG Jun;CHEN Chen;LIU Han-lin(Department of Osteology,Hanyang Hospital Affiliated to Wuhan University of Science and Technology,Wuhan 430050,China)

机构地区：[1]武汉科技大学附属汉阳医院骨科,武汉430050

出　　处：《解放军医药杂志》2021年第7期46-49,62,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：湖北省卫生健康委员会科研项目(WJ2018F032)。

摘　　要：目的分析不同骨折固定方法治疗合并开放性胫腓骨骨折的多发性损伤患者的临床效果。方法选取本院2018年10月—2020年8月收治的合并开放性胫腓骨骨折的多发性损伤86例,根据骨折固定方法的不同分为A组24例(跟骨牵引加夹板固定治疗)、B组35例(带锁髓内钉固定治疗)及C组27例(钢板螺钉固定治疗)。比较3组临床疗效、围术期指标,术前、术后4周骨代谢指标、急性时相反应蛋白,以及并发症发生情况。结果B组优良率显著高于A、C组(P<0.05)。B组术中出血量、创面愈合时间及骨折愈合时间显著少于或短于A、C组(P<0.05)。术后4周,3组Ⅰ型胶原羧基端肽β特殊序列、铜蓝蛋白、C反应蛋白水平较术前明显下降,骨碱性磷酸酶、骨钙素、转铁蛋白水平较术前明显上升,上述因子水平以B组改善更为显著,差异均有统计学意义(P<0.05)。3组均未发生骨髓炎、软组织坏死等严重并发症。结论带锁髓内钉固定、钢板螺钉固定和跟骨牵引加夹板固定均可有效治疗合并开放性胫腓骨骨折的多发性损伤患者,但以带锁髓内钉固定治疗效果更佳,临床可根据不同骨折类型选择合理的治疗方案。Objective To analyze clinical effects of different fixation methods in treatment of patients with multiple injuries complicated by open tibiofibular fracture.Methods A total of 86 patients with multiple injury complicated by open tibiofibular fracture between October 2018 and August 2020 were selected and divided into group A(n=24,calcaneal traction and splint fixation),group B(n=35,interlocking intramedullary nail fixation)and group C(n=27,plate and screw fixation)according to different fixation methods of fractures.Clinical efficacy,perioperative indexes,bone metabolism indexes before and after operation for 4 weeks,acute phase reaction protein and incidence rate of complications were compared among three groups.Results In group B,excellent and good rate was significantly higher(P<0.05),and intraoperative volume of blood loss,times of wound healing and fracture healing were significantly lower or shorter than those in groups A and C(P<0.05).After operation for 4 weeks,levels of type I collagen carboxy-terminal peptideβspecific sequence,ceruloplasmin and C-reactive protein were significantly lower,while levels of bone alkaline phosphatase,osteocalcin and transferrin were significantly higher than those before operation than those before operation among three groups;improvement conditions of the above factors was more significant in group B(P<0.05).No serious complications such as osteomyelitis or soft tissue necrosis occurred among three groups.Conclusion Interlocking intramedullary nail fixation,plate and screw fixation and calcaneal traction and splint fixation are effective in treatment of patients with multiple injuries complicated by open tibiofibular fracture,but the effect by interlocking intramedullary nail fixation is better,and the reasonable treatment scheme can be selected according to different fracture types.

关 键 词：骨折 开放性 胫腓骨 多处创伤 带锁髓内钉固定 钢板螺钉固定 骨牵引 骨折愈合时间 骨钙素 转铁蛋白 

分 类 号：R683[医药卫生—骨科学]