基于CT数据的数字六轴外固定架治疗胫腓骨骨折的临床效果研究  

Clinical study of digital six-axis external fixation frame based on CT data for tibiofibular fractures

作　　者：贾斌[1] 费晨 任敬 王敏[1] 贺金龙 许兆辰 路玉峰 齐亮 廖永华 乔锋 Jia Bin;Fei Chen;Ren Jing;Wang Min;He Jinlong;Xu Zhaochen;Lu Yufeng;Qi Liang;Liao Yonghua;Qiao Feng(Integrated Orthopedic Department of Traditional Chinese Medicine(TCM)and Western Medicine,HongHui Hospital,Xi′an Jiaotong University,Xi′an 710054,China)

机构地区：[1]西安交通大学附属红会医院中西医结合骨科,西安710054

出　　处：《中华外科杂志》2022年第6期552-557,共6页Chinese Journal of Surgery

摘　　要：目的探讨应用基于CT数据的数字六轴外固定架治疗胫腓骨骨折的临床效果。方法回顾性分析西安交通大学附属红会医院中西医结合骨科2018年1月至2021年1月应用自主研发的基于CT数据的数字六轴外固定架治疗的43例胫腓骨骨折患者的临床资料。男性27例,女性16例,年龄(36.0±9.4)岁(范围:25~50岁)。AO分型42A型15例,42B型11例,42C型17例。其中开放性骨折7例,Gustilo分型:Ⅰ型2例,Ⅱ型4例,Ⅲ型1例。将2个或3个平面环与六根连接杆连接组装成完整的六轴外固定架,通过固定针将远近段骨折块分别与平面环连接固定,术后根据CT数据,利用配套软件计算出6根连接杆需要调节的长度,然后逐一调节连接杆长度,即完成骨折的复位。通过测量术后X线片,评估六轴外固定架的复位精度;收集患者术后恢复情况及并发症情况,记录外固定架拆除时间,末次随访时根据Johner-Wruhs评分评价患肢功能。结果术后即刻X线片显示,所有患者均获得满意复位,侧方移位[M(IQR)]2.3(2.5)mm(范围:0.3~7.3 mm),前后移位2.1(2.4)mm(范围:0.3~5.7 mm),前后成角2.5(2.4)°(范围:0~5°),内外成角2.1(1.5)°(范围:0~4°),外观未发现明显的内外旋畸形。术后第2天,所有患者均可扶双侧拐杖部分负重行走,膝关节和踝关节活动度均正常。术后1个月,患者可完全负重行走,骨折处无疼痛不适,部分患者针孔处疼痛,均可忍受。43例患者均获得6个月以上随访,随访时间(33.3±7.3)周(范围:24~42周)。待骨折愈合后,拆除外固定架,拆除时间为术后20(3)周(范围:18~25周)。截至末次随访,患者均未发生二次骨折,患肢Johner-Wruhs评分为优39例,良4例。结论基于CT数据的数字六轴外固定架治疗胫腓骨骨折,具有复位精确、固定牢靠、操作简单、骨折愈合快、创伤小等优点,患者可早期下床活动,是治疗胫腓骨骨折的一种微创方法,尤其适合开放伤等皮肤软组织条件不好的Objective To investigate the clinical effect of applying the digital six-axis external fixation frame based on CT data in the treatment of tibiofibular fractures.Methods The clinical data of 43 patients with tibiofibular fractures treated by the self-developed digital six-axis external fixation frame based on CT data at Integrated Orthopedic Department of Traditional Chinese Medicine(TCM)and Western Medicine,HongHui Hospital from January 2018 to January 2021 were retrospective analysis.There were 27 males and 16 females,aged(36.0±9.4)years(range:25 to 50 years).AO classification:15 cases of 42A,11 cases of 42B,and 17 cases of 42C.There were 7 open fractures and Gustilo fracture classification:2 cases of typeⅠ,4 cases of typeⅡ,and 1 case of typeⅢ.The two or three plane rings were connected with six connecting rods to form a complete six-axis external fixation frame,and the distal and proximal fracture blocks were connected to the distal and proximal rings by fixation pins,and the lengths of the six connecting rods needed to be adjusted were calculated by using the supporting software according to the CT data after surgery,and then the lengths of the connecting rods were adjusted one by one to complete the reduction of the fracture.The reduction accuracy of this six-axis external fixation brace was evaluated by measuring postoperative radiographs;postoperative recovery and complications were collected,the time of brace removal was recorded,and the function of the affected limb was evaluated according to the Johner-Wruhs score at the final follow-up.Results Postoperative radiographs showed that all patients achieved satisfactory reduction with lateral displacement(M(IQR))of 2.3(2.5)mm(range:0.3 to 7.3 mm),anteroposterior displacement of 2.1(2.4)mm(range:0.3 to 5.7 mm),anteroposterior angulation of 2.5(2.4)°(range:0 to 5°),internal and external angulation of 2.1(1.5)°(range:0 to 4°),and no significant internal or external rotational deformity was detected on the exterior.On the second postoperative day,all

关 键 词：骨折 胫骨 腓骨 数字六轴外固定架 

分 类 号：R687.3[医药卫生—骨科学]