双反牵引外固定架结合髓内钉治疗胫骨多段骨折的临床疗效及骨折愈合的影响因素分析  

Clinical efficacy of double reverse traction external fixation frame combined with intramedullary nailing in the treatment of multiple tibial fractures and analyzation of influencing factors on healing

作　　者：张祖强 李圳 刘勇 王振龙 Zhang Zuqiang;Li Zhen;Liu Yong;Wang Zhenlong(Department of Orthopedics and Traumatology,Affiliated Hospital of Traditional Chinese Medicine,Southwest Medical University,Luzhou 646000,China;Department of Orthopedics,Xingwen County People′s Hospital,Yibin 644400,China)

机构地区：[1]西南医科大学附属中医医院骨伤科,泸州646000 [2]兴文县人民医院骨科,宜宾644400

出　　处：《中华损伤与修复杂志(电子版)》2025年第1期13-21,共9页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

摘　　要：目的探究双反牵引外固定架结合髓内钉治疗胫骨多段骨折的临床疗效及骨折愈合的影响因素。方法选取2021年2月至2022年12月西南医科大学附属中医医院骨伤科收治并完成为期1年随访的胫骨多段骨折患者110例临床资料开展分析,资料分为双反牵引器结合髓内钉组55例与传统加压钢板结合髓内钉组55例,比较两组手术相关指标、踝关节功能(Kofoed评分)、关节活动度与术后3个月骨折愈合率的差异,并分析骨折预后相关影响因素。结果双反牵引器结合髓内钉组手术时间[(64.29±17.46)min]、术中出血量[(41.99±6.21)ml]、骨折端切开率(16.36%)、骨折愈合时间[(21.82±5.76)周]、下床行走时间[(4.24±1.29)周]均低于传统加压钢板结合髓内钉组[(89.71±23.58)min、(56.69±12.00)ml、45.45%、(30.87±7.77)周、(6.36±1.75)周],且差异均有统计学意义(t/χ^(2)=5.247、6.966、10.890、6.942、7.236,P<0.05)。术后3个月骨折愈合率高于传统加压钢板结合髓内钉组(85.45%vs 67.27%)(χ^(2)=5.037,P<0.05)。重复测量方差分析结果显示,两组取外固定时、末次随访Kofoed评分均较术前均升高(P<0.05),且双反牵引器结合髓内钉组取外固定时、末次随访Kofoed评分[(83.59±5.14)分、(94.67±5.53)分]均大于传统加压钢板结合髓内钉组[(79.54±5.21)分、(88.39±5.42)分](t=3.191、4.651,P<0.05)。两组末次随访踝关节活动范围与膝关节活动范围均大于取外固定时(P<0.05),且双反牵引器结合髓内钉组患者取外固定时、末次随访踝关节活动范围与膝关节活动范围[(50.30±4.51)°、(100.81±11.96)°]均大于传统加压钢板结合髓内钉组[(37.21±4.66)°、(82.72±8.96)°](t=11.678、6.660,P<0.05)。按照患者术后骨折愈合情况分为愈合组和未愈组。Logistic回归分析显示,年龄≥60岁、高能量骨折、受伤至治疗时间≥6 h、二期修复为骨折愈合危险因素,白蛋白水平为骨折愈合保护因素(OR=9.369、4.961Objective To investigate the clinical efficacy and influencing factors of double reverse traction external fixation frame combined with intramedullary nailing in the treatment of multiple tibial fractures.Methods The clinical data of 110 patients with multiple tibia fractures who were admitted to the Department of Orthopedics and Traumatology in Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University from February 2021 to December 2022 were selected,and they were divided into 55 cases of the double-reverse retractor combined with intramedullary nailing group and 55 cases of the traditional compression plate combined with intramedullary nailing group according to the different treatment modalities,and the differences in the surgery-related indexes,ankle function(Kofoed score),joint mobility and fracture healing rate at 3 months after surgery and the factors influencing the prognosis of the fracture were analyzed.Results The operation time[(64.29±17.46)min],intraoperative bleeding[(41.99±6.21)ml],fracture end dissection rate(16.36%),fracture healing time[(21.82±5.76)weeks],and time to get out of bed[(4.24±1.29)weeks]were lower in the double retractor combined with intramedullary nailing group than in the traditional compression plate combined with intramedullary nailing group[(89.71±23.58)min,(56.69±12.00)ml,45.45%,(30.87±7.77)weeks,(6.36±1.75)weeks](t/χ^(2)=5.247,6.966,10.890,6.942,7.236,P<0.05),and the fracture healing rate was higher than that of the traditional compression plate combined with intramedullary nailing group at 3 months postoperatively(85.45%vs 67.27%)(χ^(2)=5.037,P<0.05).Repeated-measures ANOVA showed that the Kofoed scores of both groups at the time of external fixation and at the last follow-up were higher than those of the preoperative period(P<0.05),and the Kofoed scores at the time of external fixation and at the last follow-up were higher in the double-reverse retractor combined with intramedullary nailing group[(83.59±5.14)points and(94.67±5.53)points

关 键 词：胫骨多段骨折 双反牵引器 临时外固定架 疗效 影响因素 

分 类 号：R68[医药卫生—骨科学]