外固定架辅助复位交锁髓内钉固定治疗胫腓骨骨折  

The external fixator assisted reduction and interlocking intramedullary nail fixation for treatment of tibiofibular fracture

作　　者：王浩[1] 湛梅圣[1] 柯友群 张彬[1] WANG Hao;ZHAN Mei-sheng;KE You-qun;ZHANG Bin(Dept of Orthopaedics,the First People′s Hospital of Zaoyang City,Zaoyang,Hubei 441200,China)

机构地区：[1]枣阳市第一人民医院骨科,湖北枣阳441200

出　　处：《临床骨科杂志》2022年第6期881-884,共4页Journal of Clinical Orthopaedics

摘　　要：目的探讨外固定架辅助复位交锁髓内钉固定治疗胫腓骨骨折的疗效。方法将90例胫腓骨骨折患者根据手术方式不同分为观察组(采用外固定架辅助复位交锁髓内钉固定治疗,45例)和对照组(采用手法复位交锁髓内钉固定治疗,45例)。比较两组手术情况、踝关节活动度及负重情况、术后并发症发生率以及临床疗效。结果患者均获得随访,时间6~12个月。手术时间、术中透视时间、术中出血量观察组均短(少)于对照组(P<0.001)。术后6个月,观察组骨折均愈合,对照组44例患者骨折愈合,1例更换粗髓内钉固定患者骨折延迟愈合。术后4个月踝关节跖屈、背伸、内翻、外翻活动度观察组均大于对照组(P<0.05),术后开始负重时间观察组早于对照组(P<0.05)。术后并发症发生率观察组低于对照组(P<0.05)。末次随访时,采用Johner-Wruhs评分系统评价疗效:观察组优良率为93.33%,对照组优良率为77.78%,观察组高于对照组(P<0.05)。结论相较于手法复位交锁髓内钉固定,外固定架辅助复位交锁髓内钉固定治疗胫腓骨骨折,术中通过外固定架辅助复位并维持,避免了人工长时间牵引且难以很好维持稳定的缺点,缩短了手术时间及透视时间,减少了医患放射线曝露,且疗效更好。Objective To investigate the effect of external fixator assisted reduction and interlocking intramedullary nail fixation in the treatment of tibiofibular fractures.Methods Ninety patients with tibiofibular fractures were divided into observation group(45 cases were adopted with external fixator assisted reduction and interlocking intramedullary nail fixation)and control group(45 cases were treated with manual reduction and interlocking intrameduallary nail fixation),according to different surgical methods.The operation situation,ankle joint range of motion and weightbearing,the incidence rate of postoperative complications and clinical efficacy were compared between the two groups.Results All patients were followed up for 6~12 months.The operation time,intraoperative fluoroscopy time,intraoperative blood loss of the observation group were all shorter(less)than those in the control group(P<0.001).At 6months after operation,all fractures healed in observation group;in the control group,44 patients had healed,and 1 patient was delayed healing after replacement of coarse intramedullary nail fixation.At 4 months posoperation,the range of motion of ankle with plantar flexion,dorsiflexion,varus and valgus in observation group were larger than those in control group(P<0.05),and the time of starting weight-bearing of observation group was earlier than that in control group(P<0.05).The incidence rate of the postoperative complications in the observation group was lower than the control group(P<0.05).At the last follow-up,Johner-Wruhs scoring system was used to evaluate the efficacy:the excellent and good rate of observation group was 93.33%,and which of control group was 77.78%,and the observation group was higher than the control group(P<0.05).Conclusions Compared with manual reduction and interlocking intramedullary nail fixation,external fixator assisted reduction and interlocking intramedullary nail fixation is used to treat tibiofibular fractures.The external fixator is used to assist reduction and maintenance during

关 键 词：交锁髓内钉内固定 胫腓骨骨折 外固定架 

分 类 号：R683.42[医药卫生—骨科学] R687.3[医药卫生—外科学]