显微外科技术联合组合式外固定架在胫腓骨远端骨折伴严重软组织损伤中的应用  

Application of microsurgical technique plus combined external fixator in distal tibia-fibula fractures with severe soft tissue injury

作　　者：李克亚 刘鹏 王胜杰 刘兵 LI Keya;LIU Peng;WANG Shengjie;LIU Bing(Hengshui People's Hospital,Hengshui 053000,China.)

机构地区：[1]衡水市人民医院,河北省衡水市053000

出　　处：《组织工程与重建外科》2024年第1期87-92,共6页Journal of Tissue Engineering and Reconstructive Surgery

基　　金：河北省医学科学研究重点课题计划(20177058)。

摘　　要：目的探索显微外科技术联合组合式外固定架在胫腓骨远端骨折伴严重软组织损伤中的应用效果。方法选取2021年1月至2022年6月收治的84例胫腓骨远端骨折伴严重软组织损伤患者,根据治疗术式不同分为两组,采取弹性髓内钉固定治疗的41例为对照组,采取显微外科技术联合组合式外固定架治疗的43例为观察组。观察两组手术相关情况、术后疗效、术后并发症及不同时间点X射线骨痂评分、血清指标(BMP-2、VEGF、TGF-β),以及踝关节功能(AOFAS)评分、Molander踝关节骨折评分系统(OMAS)评分。结果观察组术前准备、手术操作、住院、完全负重、创面愈合及骨折愈合时间均短于对照组,创面换药次数少于对照组(P<0.05);观察组术后1、3个月X射线骨痂评分高于对照组(P<0.05);观察组术后1、3个月血清BMP-2、VEGF、TGF-β水平高于对照组(P<0.05);术后3个月观察组手术优良率及AOFAS、OMAS评分均高于对照组,术后并发症发生率低于对照组(P<0.05)。结论显微外科技术联合组合式外固定架方案治疗胫腓骨远端骨折伴严重软组织损伤能有效固定骨折,较好保护与促进软组织修复,有利于促进骨折愈合与早期肢体功能恢复,且能降低并发症发生风险。Objective To explore the application effect of microsurgical technique plus combined external fixator in the treatment of distal tibia-fibula fracture with severe soft tissue injury.Methods A total of 84 patients with distal tibia-fibula fracture with severe soft tissue injury from January 2021 to June 2022 were selected and divided into two groups according to different treatment methods:41 patients treated with elastic intramedullary nail were included in the control group,and 43 patients treated with microsurgical technique combined with external fixators were included in the observation group.The operation related situation,postoperative efficacy,postoperative complications,X-ray callus score,serum indexes(BMP-2,VEGF,TGF-β),ankle function(AOFAS)score,Molander ankle fracture scoring system(OMAS)score were compared between the two groups.Results The time of preoperative preparation,operation,hospitalization,complete weight bearing,wound healing and fracture healing in the observation group were shorter than those in the control group,and the times of wound dressing changes were less than those in the control group(P<0.05).The X-ray callus score of the observation group was higher than that of the control group at 1 and 3 months after surgery(P<0.05).The levels of serum BMP-2,VEGF and TGF-βin the observation group were higher than those in the control group at 1 month and 3 months after surgery(P<0.05).Three months after operation,the good and excellent rate of operation,AOFAS and OMAS scores in observation group were higher than those in control group,and the incidence of postoperative complications was lower than that in the control group(P<0.05).Conclusion Microsurgical technique plus combined external fixator in the treatment of distal tibia-fibula fracture with severe soft tissue injury can effectively fix the fracture,better protect and promote soft tissue repair,promote fracture healing and early limb functional recovery,and reduce the risk of complications.

关 键 词：胫腓骨骨折 软组织损伤 显微外科技术 组合式外固定架 X射线骨痂评分 踝关节功能 

分 类 号：R683.42[医药卫生—骨科学]