Ilizarov骨短缩-延长术联合皮瓣修复对胫腓骨骨折伴软组织缺损患者应激反应及下肢功能的影响  

Clinical effect of Ilizarov bone shortening-lengthening combined with flap repair on stress response and lower limb function of patients with tibia-fibula fracture and soft tissue defect

作　　者：孙庆禄 田连国 高鸣[1] 胡志勇 SUN Qing-lu;TIAN Lian-guo;GAO Ming(Department of Orthopedics,Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine,Cangzhou Hebei 061000,China;Department of Orthopedics,the Third People's Hospital of Botou City,Cangzhou Hebei 062150,China)

机构地区：[1]河北省沧州中西医结合医院骨科,河北沧州061000 [2]泊头市第三人民医院骨科,河北沧州062150

出　　处：《临床和实验医学杂志》2025年第2期180-184,共5页Journal of Clinical and Experimental Medicine

基　　金：河北省卫健委医学科学研究课题(编号:20210573)。

摘　　要：目的研究Ilizarov骨短缩-延长术联合皮瓣修复对胫腓骨骨折伴软组织缺损患者应激反应及下肢功能的影响。方法回顾性选择2020年7月至2022年7月间沧州中西医结合医院收治的80例胫腓骨骨折伴软组织缺损患者作为研究对象。按照治疗方案不同进行分组:观察组40例、对照组40例。观察组给予Ilizarov骨短缩-延长术联合皮瓣修复,对照组给予骨折复位术联合皮瓣修复。评价两组患者手术前、手术后3 d的应激指标[甲肾上腺素(NE)、肾上腺素(E)、皮质醇、醛固酮]水平,手术前和手术后1周患者的疼痛情况[视觉模拟评分法(VAS)评分],手术前和手术后12个月的下肢功能[踝-后足评分系统(AOFAS)评分和关节美国特种外科医院(HSS)测评量表评分],统计两组患者并发症发生情况。结果手术后3 d,两组患者的NE、E、皮质醇、醛固酮水平均较手术前降低,且观察组患者的NE、E、皮质醇、醛固酮水平分别为(1.22±0.15)mmol/L、(0.71±0.33)mmol/L、(227.81±17.26)μg/L、(41.33±4.12)pg/mL,均明显低于对照组[(1.39±0.32)mmol/L、(0.91±0.32)mmol/L、(241.39±17.83)μg/L、(48.39±4.15)pg/mL],差异均有统计学意义(P<0.05)。手术后1周,两组患者的VAS评分均较手术前降低,且观察组患者的VAS评分为(2.17±0.98)分,明显低于对照组[(3.62±1.23)分],差异均有统计学意义(P<0.05)。手术后12个月,两组患者的AOFAS评分和HSS评分均较手术前升高,且观察组患者AOFAS评分和HSS评分分别为(86.41±4.47)、(87.22±3.12)分,均明显高于对照组[(80.28±4.12)、(81.48±3.26)分],差异均有统计学意义(P<0.05)。观察组与对照组患者的总并发症发生率比较(7.50%vs.12.50%),差异无统计学意义(P>0.05)。结论与复位术联合皮瓣修复术相比,Ilizarov骨短缩-延长术联合皮瓣修复治疗胫腓骨骨折伴软组织缺损,可减轻应激反应,减轻疼痛,改善患者的下肢功能,并发症发生率较低,值得临床推广。Objective To study the effect of Ilizarov bone shortening-lengthening combined with flap repair on stress response and lower limb function of patients with tibial and fibula fracture with soft tissue defect.Methods A retrospective study was conducted on 80 patients with tibiofibular fracture and soft tissue defect admitted to Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from July 2020 to July 2022.They were divided into the two groups according to different treatment regimens:40 cases in the observation group and 40 cases in the control group.The observation group was given Ilizarov bone shortening-lengthening combined with flap repair,and the control group was given fracture reduction combined with flap repair.The levels of stress indexes[norepinephrine(NE),epinephrine(E),cortisol and aldosterone]before operation and 3 days after operation,pain[visual analogue scale(VAS)score]before operation and 1 week after operation,lower limb function[ankle-hindfoot scoring system(AOFAS)score and hospital for special knee surgery(HSS)score]before operation and 12 months after operation were evaluated in the two groups,and the incidence of complications in the two groups was statistically analyzed.Results At 3 days after operation,the levels of NE,E,cortisol and aldosterone in the two groups were lower than those before operation,and the levels of NE,E,cortisol and aldosterone in the observation group were(1.22±0.15)mmol/L,(0.71±0.33)mmol/L,(227.81±17.26)μg/L,(41.33±4.12)pg/mL,respectively,which were significantly lower than those in the control group[(1.39±0.32)mmol/L,(0.91±0.32)mmol/L,(241.39±17.83)μg/L,(48.39±4.15)pg/mL],and the differences were statistically significant(P<0.05).At 1 week after operation,the VAS scores of the two groups were lower than those before operation,and the VAS score of the observation group was(2.17±0.98)points,which was significantly lower than that of the control group[(3.62±1.23)points],the differences were statistically significant(P<0.05).At 12 months

关 键 词：胫腓骨骨折伴软组织缺损 Ilizarov骨短缩-延长术 外科皮瓣 修复 应激反应 下肢功能 

分 类 号：R68[医药卫生—骨科学]