两种不同外固定支架治疗胫骨远端骨折的疗效比较

Unilateral versus bilateral external fixator in surgical treatment of distal tibial fracture

目的比较两种不同外固定支架治疗胫骨远端骨折的疗效。方法对2005年8月至2010年2月分别采用跨关节单边外固定支架和双边组合式外固定支架治疗并获得随访的38例胫骨远端骨折患者资料进行分析，其中单边外固定支架组（A组）23例，男16例，女7例；年龄24～64岁，平均46．5岁；双边外固定支架组（B组）15例，男11例，女4例；年龄32～65岁，平均49．1岁，记录骨折愈合时间、并发症发生率，并按照美国足踝外科协会（AOFAS）的标准评价踝关节功能，比较两组患者的疗效。结果所有患者术后获6—48个月（平均21个月）随访。骨折愈合时间：A组为3．5～12个月，平均（6．8±2．0）个月；B组为3—10个月（平均5．6-I-1．5）个月，两组比较差异有学意义（t=2．074，P=0．046）。按照AOFAS标准进行评分：A组平均为（76．7±13．5）分，外固定期间并发症发生率为34．8％（8／23）；13组平均为（74．4±13．6）分，外固定期间并发症发生率为40．0％（6／15）。两组并发症发生率与AOFAS评分比较差异无统计学意义（P〉0．05）。结论单边外固定支架固定与双边组合式外固定支架固定均是治疗胫骨远端骨折的有效固定方式，在骨折愈合的时间方面，双边外固定支架较单边外固定支架具有优势。

Objective To compare unilateral and bilateral external fixators in the surgical treatment of fractures of distal tibia. Methods From August 2005 to February 2010, 38 patients with distal tibial fracture were treated surgically in our department. Of them, 23 （group A） were fixed with unilateral external fixator （16 males and 7 females with a mean age of 46.5 years）, and 15 （group B） fixed with bilateral external fixator （ 11 males and 4 females with a mean age of 49. 1 years） . All the patients were followed up periodically after operation. Time of fracture healing, complications, the American Orthopaedic Foot and Ankle Society （AOFAS） scores for the ankle were documented and analyzed statistically to compare the clinical outcomes of the 2 groups. Results The patients were followed up for 6 to 48 months （mean, 21 months）. The mean time for clinical fracture union was 6. 8 ± 2.0 months （3.5 to 12.0 months） for group A, and 5.6 ±1.5 months （3 to 10 months） for group B. The complication rates during external fixation were 34.8% （8/23） for group A and 40. 0% （6/15） for group B. The AOFAS scores for functional recovery were 76.7 ± 13.5 for group A and 74.4 ± 13.6 for group B. Independent samples t test showed a significant difference （ P 〈 0. 05） between the 2 groups in time of clinical fracture union, but no significant difference （ t = 2. 074, P = 0. 046） in complication rates and AOFAS scores. Conclusion Both unilateral and bilateral external fixators are effective for fixation of distal tibial fractures, but bilateral external fixators may be better in time of fracture healing.