锁定加压接骨板皮外固定与传统外固定支架治疗胫骨开放性骨折的疗效对比研究

COMPARISON STUDY ON LOCKING COMPRESS PLATE EXTERNAL FIXATOR AND STANDARD EXTERNAL FIXATOR FOR TREATMENT OF TIBIAL OPEN FRACTURES

目的比较锁定加压接骨板（locking compressplate,LCP）皮外固定与传统外固定支架治疗胫骨开放性骨折的疗效。方法回顾分析2009年5月-2012年6月收治且符合选择标准的59例胫骨开放性骨折患者临床资料,其中36例采用LCP皮外固定（A组）,23例采用外固定支架固定（B组）。两组患者性别、年龄、致伤原因、侧别、骨折分型及部位、受伤至手术时间比较,差异均无统计学意义（P〉0.05）。对两组患者切口愈合时间,开始部分负重活动时间,骨折愈合时间,患肢膝、踝关节活动范围及并发症等进行比较分析。结果术后A组无钉道感染发生（0）,B组5例发生钉道感染（21.7%）,比较差异有统计学意义（P=0.007）;两组切口浅表、深部感染发生率及切口愈合时间比较,差异均无统计学意义（P〉0.05）。A、B组分别有5例（13.9%）及2例（8.7%）发生下肢深静脉血栓形成,比较差异无统计学意义（χ2=0.036,P=0.085）。患者均获随访,A组平均随访时间15.2个月（9～28个月）,B组平均随访时间18.6个月（9～47个月）。A组骨折畸形愈合、不愈合发生率（0、0）,与B组（13.0%、8.7%）比较差异无统计学意义（P〉0.05）;A组骨折延迟愈合发生率（2.8%）显著低于B组（21.7%）,差异有统计学意义（χ^2=5.573,P=0.018）。A组骨折愈合时间显著短于B组,开始部分负重活动时间显著早于B组,取外固定时及末次随访时膝、踝关节活动范围均优于B组,差异均有统计学意义（P〈0.05）。结论LCP皮外固定治疗胫骨开放性骨折,具有固定可靠,患者依从性良好,有利于进行积极功能锻炼,促进骨折愈合和功能恢复,减少了并发症的发生。

Objective To compare the clinical results of locking compress plate （LCP） as an external fixator and standard external fixator for treatment of tibial open fractures. Methods Between May 2009 and June 2012, 59 patients with tibial open fractures were treated with LCP as an external fixator in 36 patients （group A）, and with standard external fixator in 23 patients （group B）. There was no significant difference in gender, age, cause of injury, affected side, type of fracture, location, and interval between injury and surgery between 2 groups （P 〉 0.05）. The time of fracture healing and incision healing, the time of partial weight-bearing, the range of motion （ROM） of knee and ankle, and complications were compared between 2 groups. Results The incidence of pin-track infection in group A （0） was significantly lower than that in group B （21.7%） （P=0.007）. No significant difference was found in the incidence of superficial infection and deep infection of incision, and the time of incision healing between 2 groups （P 〉 0.05）. Deep vein thrombosis occurred in 5 cases of group A and 2 cases of group B, showing no significant difference （x^2=0.036, P=0.085）. All patients were followed up 15.2 months on average （range, 9-28 months） in group A, and 18.6 months on average （range, 9-47 months） in group B. The malunion rate and nonunion rate showed no significant difference between groups A and B （0 vs. 13.0% and 0 vs. 8.7%, P 〉 0.05）; the delayed union rate of group A （2.8%） was significantly lower than that of group B （21.7%） （X^2=5.573, P=0.018）. Group A had shorter time of fracture healing, quicker partial weight-bearing, greater ROM of the knee and ankle than group B （P 〈 0.05）. Condusion The LCP external fixator can obtain reliable fixation in treating tibial open fracture, and has good patients＇ compliance, so it is helpful to do functional exercise, improve fracture healing and function recovery, and reduce the complication incidence.