单侧外固定支架骨结构重建治疗胫腓骨骨折的临床分析

Treatment for unstable fractures of tibia and fibula by combination of simple internal fixation and external fixator

目的:总结分析单侧外固定支架（外支架）结合骨结构重建治疗胫腓骨不稳定骨折的临床效果。方法:对53例胫腓骨不稳定骨折予小切口下有限内固定,植骨等方式行骨结构重建并结合外支架固定。结果:53例中有86.8％（46例）正常骨愈合,延迟愈合5例,畸形愈合2例,占13.2％。针道感染有9.5％（5例）。踝关节背伸僵硬有5.7％（3例）,无针道松动及断针。结论:（1）外支架可为骨折提供良好生物学环境,但存在抗压、抗弯性能弱的缺点;（2）通过骨折骨结构重建稳定骨界面,应用“6”针固定,增加阻力臂缩短动力臂,缩短骨架间距等措施维护及提高其生物刚度;（3）术后适时调节刚度,使高强度固定向弹性固定过渡利于骨折愈合。

Objective:To evaluate the mechanical and clinical advantages of unilateral external fixator combined with simple internal fixation for the treatment of unstable tibial and fibular fracture. Methods: Fifty-three cases with unstable tibial and fibular fracture were treated with a simple internal fixation or bone grafting and unilateral external fixation after limited incision. Results: The bone fractures were normally healed in 46 cases (86.8 % ) ; delayed healed in 5 cases and abnormally healed in 2 cases (13.2%).The infection in wire holes was found in 5 cases (9.5%); stiff ankles were in 3 cases(5. 7%) and no wires break or loose were found. Conclusion: A good biomechanical and biological environment should be provided for fracture healing.The application of a unilateral external fixator can preserve good biologyical environment for the fracture healing, but it is fragile against bending and pressing force. To restore the structure of the fractured bone, the biological rigidity of the external fixator can be improved by using 6 wires fixation, increasing resistance arm and decreasing dynamical arm of the fixator,reducing the distances between bone and fixator. The fixation of the external fixator can be adjusted gradually from high rigidity to elasticity which is helpful for the fracture healing.