基于CT数据六轴外固定架与内固定在矫正胫骨畸形中的应用  

Comparison of the Application of Six-Axis External Fixator Based on CT Data and Internal Fixation in the Correction of Tibial Deformity

作　　者：许兆辰 陈永程 张保刚 张萌 乔锋 Xu Zhaochen;Chen Yongcheng;Zhang Baogang;Zhang Meng;Qiao Feng(Department of Orthopaedics,Integrated Traditional Chinese and Western Medicine,Xi'an Honghui Hospital,Xi'an 710054,China;Shaanxi University of Traditional Chinese Medicine,Xianyang 712046,China;Xi'an Haitang Technician College,Xi'an 710038,China)

机构地区：[1]西安市红会医院中西医结合骨科,陕西西安710054 [2]陕西中医药大学,陕西咸阳712046 [3]西安海棠技师学院,陕西西安710038

出　　处：《实用骨科杂志》2024年第4期311-316,共6页Journal of Practical Orthopaedics

基　　金：陕西省重点研发计划(2023-YBSF-675)。

摘　　要：目的探讨基于CT数据六轴外固定架与内固定矫正胫骨畸形的临床疗效。方法回顾性分析2019年1月至2023年1月接受胫骨畸形矫正的60例患者的临床资料,根据术式选择分为内固定组30例,外固定架组30例。内固定组男9例,女21例;平均年龄(32.83±7.73)岁。外固定架组男15例,女15例;平均年龄(31.17±8.43)岁。比较两组患者的手术情况、截骨处愈合时间、术后并发症发生情况及术后随访的影像学测量指标。结果两组患者均获随访,随访时间6~15个月,平均(6.97±1.69)个月。与内固定组比较,外固定架组的切口长度更短(P<0.05),截骨处愈合时间较长(P<0.05);在手术时间、出血量、下地时间、住院时间、并发症方面,两组差异无统计学意义(P>0.05);术前两组的机械轴偏移(mechanical axis deviation,MAD)、股胫角(femoro tibial angle,FTA)、胫骨近端内侧角(medial proximal tibial angle,MPTA)、胫骨远端外侧角(lateral distal tibial angle,LDTA)、股骨远端外侧角(lateral distal femoral angle,LDFA)、关节线相交角(joint line convergence angle,JLCA)、双下肢长度差(leg length discrepancy,LLD)差异无统计学意义(P>0.05);术后两组的FTA、MPTA、LDTA、LDFA、JLCA差异无统计学意义(P>0.05),外固定架组的MAD、LLD小于内固定组,差异有统计学意义(P<0.05);与术前比较,内固定组术后的MAD、FTA、MPTA、LDTA、JLCA差异有统计学意义(P<0.05),外固定架术后的MAD、FTA、MPTA、LDTA、JLCA、LLD差异有统计学意义(P<0.05)。结论外固定架与内固定矫正胫骨畸形具有相同临床疗效,但外固定架矫正畸形具有切口较小、创伤小、精确性高、可术后多次调整等优点,对于合并LLD者尤为适宜,值得临床推广应用。Objective To investigate the clinical efficacy of six-axis external fixator based on CT data and internal fixation in the correction of tibial deformity.Methods The clinical data of 60 patients who underwent tibial deformity correction from January 2019 to January 2023 were retrospectively analyzed.According to the choice of operation,they were divided into internal fixation group(30 cases)and external fixation group(30 cases).There were 9 males and 21 females in the internal fixation group,with an average age of(32.83±7.73)years old.There were 15 males and 15 females in the external fixation group,with an average age of(31.17±8.43)years old.The surgical conditions,osteotomy healing time,postoperative complications and postoperative follow-up imaging measurement indicators were compared between the two groups.Results All patients were followed up for 6~15 months,with an average of(6.97±1.69)months.Compared with the internal fixation group,the incision length of the external fixation group was shorter(P<0.05),and the healing time of the osteotomy was longer(P<0.05).There was no significant difference between the two groups in operation time,blood loss,ambulation time,hospitalization time and complications(P>0.05).There was no significant difference in mechanical axis deviation(MAD),femoro tibial angle(FTA),medial proximal tibial angle(MPTA),lateral distal tibial angle(LDTA),lateral distal femoral angle(LDFA),joint line convergence angle(JLCA),and leg length discrepancy(LLD)between the two groups before operation(P>0.05).There was no significant difference in FTA,MPTA,LDTA,LDFA and JLCA between the two groups after operation(P>0.05).TheMAD and LLD of the external fixation group were smaller than those of the internal fixation group,and the difference was statistically significant(P<0.05).Comparison with preoperative,there were statistically significant differences in MAD,FTA,MPTA,LDTA and JLCA after operation in the internal fixation group(P<0.05),and there were statistically significant differences in MAD,FTA,M

关 键 词：胫骨畸形 外固定架 内固定 截骨矫形 

分 类 号：R682.6[医药卫生—骨科学]