足中立位外固定联合生物护创膜治疗预防小腿部骨折术后马蹄足

Prevention of equinus following crus fracture operation using plaster external fixation withfoot in neutral position combined with aseptic biologic film

目的：观察小腿部骨折患者术中应用无菌生物护创膜（以下简称护创膜）、术后置足于中立位短腿石膏托外固定预防马蹄足并发症的治疗效果.方法：回顾总结2013年9月-2016年6月收治60例成人小腿部骨折患者随机分组的相关资料.观察组30例,术中应用护创膜、术后置足中立位短腿石膏托外固定治疗,对照组30例未用护创膜和石膏托.通过统计学分析比较2组患者末次随访时伸膝0°位和屈膝90°位踝关节背屈最大角度值（x±s）差异,以及2组腓肠肌挛缩型和跟腱挛缩型马蹄足发生率差异.结果：60例均获得随访,随访时间6-16个月,平均9.2个月.2组一般情况比较,差异无统计学意义,有可比性.观察组分别在伸膝0°位、屈膝90°位时踝关节背屈角度10.9°±1.7°、12.1°±1.7°,均好于对照组6.9°±4.2°、9.7°±3.2°,并且腓肠肌挛缩型、跟腱型马蹄足发生率低于对照组,P〈0.05,差异有统计学意义.结论：小腿部骨折患者在术中应用无菌生物护创膜、术后足置于中立位短腿石膏托外固定的治疗,配合功能锻炼,对预防小腿三头肌挛缩型马蹄足效果满意.

Objective： To observe the effect of applying aseptic biologic film during crus fracture operation and plaster external fixation with foot in neutral position after operation in preventing equinus among crus fracture patients. Methods： Sixty crus fracture patients recruited from September 2013 to June 2016 were randomly assigned to treatment group and control group. The treatment group was applied with aseptic biologic film during operation and plaster external fixation with foot in neutral position after operation, while the control group was treated as usual. The maximal angle of ankle dorsiflexion when the knee was extended at 0°and bent at 90°（x ± s）, the incidence of equinus of gastrocnemius contracture and achilles tendon contracture at the end of follow - up were compared between the two groups using statistic analysis. Results： All 60 patients completed the follow - up, with a mean follow - up period of 9.2 months （ ranging from 6 to 16 months）. The maximal angle of ankle dorsiflexion when the knee was extended at 0°and bent at 90° were higher in the treatment group （10.9° ± 1.7°/12.1 °± 1.7°） than in the control group（6.9° ± 4.2°/9.7° ± 3.2°） , the incidence of equinus of gastrocnemius contracture and achilles tendon contracture were lower in the treatment group than in the control group, all differences were statistically significant （ p 〈 0.05 ） Conclusion： Applying aseptic biologic film during crus fracture operation and plaster external fixation with foot in neutral position after operation, combined with functional exercise were effective in preventing equinus of triceps surae contracture.