牵引式外固定支架治疗胫腓骨骨折伴筋膜间隔综合征的疗效  

Efficacy of distracting external fixator for tibiofibular fractures combined with osteofascial compartment syndrome

作　　者：李颖 杨俊生[1] 杨智伟 童梁成 赵磊 汪剑龄 孙中洋 薛庆 Li Ying;Yang Junsheng;Yang Zhiwei;Tong Liangcheng;Zhao Lei;Wang Jianling;Sun Zhongyang;Xue Qing(Department of Orthopedics,Air Force Hospital from Eastern Theater of PLA,Nanjing 210002,China;Clinical College,Anhui Medical University,Hefei 230032,China)

机构地区：[1]解放军东部战区空军医院骨科,南京210002 [2]安徽医科大学临床学院,合肥230032

出　　处：《中华创伤杂志》2021年第12期1078-1082,共5页Chinese Journal of Trauma

摘　　要：目的探讨采用牵引式外固定支架治疗胫腓骨骨折伴筋膜间隔综合征的疗效。方法采用回顾性病例对照研究分析2009年3月至2019年3月解放军东部战区空军医院收治的62例胫腓骨骨折伴筋膜间隔综合征患者的临床资料,其中男47例,女15例;年龄20~78岁[(47.1±13.4)岁]。胫骨干骨折30例,胫骨平台骨折17例,胫骨远端骨折15例。骨折AO/OTA分型:4A型18例,4B型24例,4C型20例。30例采用牵引式外固定支架牵引(A组),32例采用跟骨结节牵引(B组)。比较两组牵引后第3天的伤肢谷丙转氨酶(ALT)、尿素氮(BUN)、肌酸激酶(CK)、乳酸脱氢酶(LDH)水平。比较两组筋膜切开率、损害控制性治疗时间(外伤至Ⅱ期确定性手术前的观察时间)、Ⅱ期确定性手术时间、Ⅱ期确定性手术内固定方式、针道感染率和非计划二次手术率。末次随访时采用Johner-Wruhs评分系统评价患肢功能。结果患者均获随访12~22个月[(15.1±2.7)个月]。A组CK为315.6(140.0,531.5)U/L,显著低于B组的465.5(277.0,1240.5)U/L(P<0.05);两组ALT、BUN及LDH水平差异均无统计学意义(P>0.05)。A组筋膜切开率[40%(12/30)]高于B组[34%(11/32)],但差异无统计学意义(P>0.05);A组Ⅱ期确定性手术时间为(68.5±17.1)min,显著低于B组的(89.0±15.1)min(P<0.05)。A组非计划二次手术率[3%(1/30)]低于B组[25%(8/32)](P<0.05)。两组损害控制性治疗时间、Ⅱ期确定性手术内固定方式、针道感染率差异均无统计学意义(P>0.05)。末次随访时A组Johner-Wruhs评分优17例,良5例,中2例,差6例,优良率为73%;B组优13例,良3例,中7例,差9例,优良率为50%(P>0.05)。结论与跟骨结节牵引比较,牵引式外固定支架可以减轻胫腓骨骨折伴筋膜间隔综合征患者软组织损伤进一步加重,术中维持骨折复位有助于缩短Ⅱ期确定性手术时间。Objective To explore the efficacy of distracting external fixator for tibiofibular fractures combined with osteofascial compartment syndrome.Methods A retrospective case-control study was conducted to analyze the clinical data of 62 patients with tibiofibular fractures combined with osteofascial compartment syndrome admitted to Air Force Hospital from Eastern Theater of PLA from March 2009 to March 2019,including 47 males and 15 females,aged 20-78 years[(47.1±13.4)years].There were 30 patients with tibia shaft fractures,17 with tibia plateau fractures and 15 with tibia distal fractures.The fractures were classified as type 4A in 18 patients,type 4B in 24 and type 4C in 20 according to AO/OT classification.Distracting external fixation was performed for 30 patients(Group A)and calcaneal tuberosity traction for 32 patients(Group B).Levels of alanine aminotransferase(ALT),urea nitrogen(BUN),creatine kinase(CK)and lactate dehydrogenase(LDH)of the injured limb were compared between the two groups during traction.Additionally,the fasciotomy rate,time of damage control treatment(observation interval from trauma to stage II definitive surgery),time of stage II definitive surgery,internal fixation modalities of stage II definitive surgery,rate of needle tract infection and rate of non-planned secondary surgery were compared between the two groups.The limb function was assessed using Johner-Wruhs scoring system at the last follow-up.Results All patients were followed up for 12-22 months[(15.1±2.7)months].Level of CK in Group A was 315.6(140.0,531.5)U/L,significantly lower than that in Group B[465.5(277.0,1240.5)U/L](P<0.05).The two groups revealed no statistical differences in levels of BUN,CK and LDH(P>0.05).The fasciotomy rate in Group A[40%(12/30)]was higher than that in Group B[34%(11/32)],but the difference was statistically insignificant(P>0.05).The time of stage II definitive surgery in Group A was(68.5±17.1)minutes,significantly lower than that in Group B[(89.0±15.1)minutes](P<0.05).The rate of non-planned seco

关 键 词：骨折 胫骨 腓骨 外固定器 损害控制 

分 类 号：R687.3[医药卫生—骨科学]