自行研制的胫骨可调负重支具在AO分型42-B型胫骨干骨折髓内钉固定术后的应用

Self-designed adjustable tibial weight-bearing brace for AO type 42-B tibial shaft fractures

目的探讨自行研制的胫骨可调负重支具辅助治疗AO分型42-B型闭合性胫骨干骨折髓内钉固定术后患者的临床疗效。方法选取2013年4月至2015年3月连续收治的68例闭合B型胫骨干骨折髓内固定术后患者，采用随机数字表法平均分成A、B两组（n=34），其中A组患者按胫骨干骨折术后常规处理，B组患者在此基础上，术后1周加用胫骨可调负重支具治疗。记录并比较两组患者术后3、6个月疼痛视觉模拟评分（VAS）、术后1、3、6个月患肢负重情况、骨折临床愈合时间、胫骨骨折影像学愈合（RUST）评分和及末次随访时Johner—Wruhs评分。结果62例患者术后获12—18个月（平均14．7个月）随访，5例患者失访，1例患者退出试验。术后第3、6个月B组患者VAS评分平均分别为（2．5±0．8）、（0．9±0．6）分，均显著低于A组患者[（3．0±0．9）、（1．4±0．8）分]差异有统计学意义（P〈0．05）；术后1、3、6个月A组患者的患肢负重情况平均分别为44．1％±17．5％、72．0％±17．4％、86．4％±12．5％，RUST评分平均分别为（5．4±1．4）、（8．7±1．1）、（10．3±1．1）分；B组患者患肢负重情况平均分别为53．8％±11．0％、84．1％±12．2％和94．4％±10．6％，RUST评分平均分别为（6．5±0．8）、（9．9±0．9）、（11．3±0．8）分，以上项目两组间比较差异均有统计学意义（P〈0．05）。B组患者的骨折临床愈合时间平均为（3．3±0．7）个月，明显短于A组患者[（3．9±1．0）个月]，差异有统计学意义（P〈0．05）。末次随访时Johner—Wruh评分示：A组优19例，良12例；B组优27例，良4例，两组间比较差异有统计学意义（P〈0．05）。结论B型闭合胫骨干骨折髓内固定术后早期应用自行研制的胫骨可调负重支具较常规术后处理可更明显地减少患肢术后疼痛、加速骨痂生长、缩短骨折临床愈合时间，术后患者功能恢复满意。

Objective To investigate the clinical efficacy of our self-designed adjustable weight-bearing brace for AO type B tibial shaft fractures managed by interlocking intramedullary nail. Methods A total of 68 consecutive patients with AO type 42-B tibial shaft fracture who had been managed from April 2013 to March 2015 by interlocking intramedullary nail were recruited into our study. They were randomized into 2 equal groups （ n = 34）. Group A received conventional therapy after operation while group B received auxiliary management with our self-designed adjustable weight-bearing brace after conventional postoperative therapy for one week. The 2 groups were compared at postoperative 1, 3 and 6 months and at the final follow-up in terms of visual analogue scale （VAS）, weight-bearing status of the affected limb, time for fracture union, Radiographic Union Score for Tibial Fractures （RUST） and Johner-Wruhs scale. Results Of this series, 62 cases were followed up for 12 to 18 months （average, 14. 7 months）, 5 ones were lost to the follow-up and one withdrew. The mean VAS scores at 3-month and 6-month follow-ups for group B were 2. 5 ± 0. 8 and 0. 9 ± 0.6 respectively, significantly lower than those for group A （3.0 ± 0. 9 and 1.4 ± 0. 8 respectively） （ P 〈 0. 05） . In group A at l-month, 3-month and 6-month follow-ups, the weight-bearing status was 44. 1% ± 17. 5%, 72. 0% ± 17.4% and 86. 4% ± 12. 5% while the mean RUST scores were 5.4 ± 1.4, 8.7 ± 1. 1 and 10. 3 ± 1. 1, respectively. In group B at 1-month, 3-month and 6-month follow-ups, the weight-bearing status was 53.8% ± 11.0%, 84. 1% ± 12. 2% and 94.4% ± 10. 6% while the mean RUST scores were 6.5 ±0. 8, 9.9 ±0. 9 and 11.3 ±0. 8, respectively. There were significant differences between the 2 groups in the above indexes （all P 〈 0. 05）. Group B achieved clinical fracture union after an average of 3.3 ±0.7 months, significantly faster than group A （3.9 ± 1.0 months） （P 〈 0. 05）. According to the Johner-Wruhs scoring, group A had 19 excellent cases and 12 good ones while group B had 27 excellent ones and 4 good ones, showing a significant difference between the 2 groups （ P 〈 0.05）. Conclusions Early application of our self-designed adjustable weight-bearing brace for patients with AO type B tibial shaft fracture managed by interlocking intramedullary nail can reduce postoperative pain, accelerate callus growth, shorten bony healing time and achieve satisfactory functional recovery.