一期支架外固定联合二期髓内钉固定治疗胫骨干开放性骨折的疗效分析

Treatment of open fracture of tibial shaft with external fixation at first stage combined with intramedullary nail internal fixation at second stage

目的探讨一期支架外固定联合二期髓内钉固定在胫骨干开放性骨折中的应用效果。方法胫骨干开放性骨折病人80例。根据治疗方式不同分为观察组和对照组,每组各40例。观察组一期采用支架外固定,二期采用髓内钉固定;对照组一期采用髓内钉固定。比较两组病人手术一般情况、骨折复位、愈合情况和Rasmussen评分,比较两组病人术后第1天和7天时的周径差和疼痛程度。结果观察组、对照组手术优良率分别为95.0%和80.0%,两组比较差异有统计学意义(P<0.05);术后1天两组周径差分别为(5.41±1.02)cm和(5.38±0.97)cm,疼痛程度分别为(7.47±1.23)和(7.44±1.08),两组比较差异均无统计学意义(P>0.05);观察组、对照组术后7天周径差分别为(1.13±0.35)cm和(2.54±0.67)cm,疼痛程度分别为(2.34±0.76)和3.59±0.88,两组比较差异均有统计学意义(P<0.05);两组病人术后1个月的Rasmussen评分分别为(15.25±2.03和(15.28±2.11,两组比较差异无统计学意义(P>0.05),观察组术后3个月和术后6个月的Rasmussen评分分别为(20.75±3.05)和(27.35±3.78),对照组分别为(18.34±3.02)和(23.71±3.64),两组比较差异均有统计学意义(P<0.05);观察组切口愈合时间和骨痂出现时间分别为(15.67±3.08)天和(4.15±0.98)周,对照组分别为(18.25±3.13)天和(5.82±1.01)周,两组比较差异均有统计学意义(P<0.05)。结论一期支架外固定联合二期髓内钉固定在胫骨干开放性骨折中有较好的治疗效果。

Objective To evaluate the effect of external fixation at first stage combined with intramedullary nail internal fixation at second stage on treating open fracture of tibial shaft. Methods A total of 80 patients with open fracture of tibial shaft treated in our hospital from April 2016 to April 2017 were selected as the subjects. According to the treatment methods,they were divided as control group and observation group with 40 cases in each group. The control group was given intramedullary nail internal fixation and the observation group was given external fixation at first stage combined with intramedullary nail internal fixation at second stage. The general operation condition of the two groups was observed and the fracture reduction,healing and Rasmussen score were compared between the two groups. The difference of the circumference and pain degree between the two groups after 1,3 and 7 days were compared. Results The operative excellence rate of the observation group was significantly higher than that of the control group,and there was no difference in circumference and pain between the two groups after 1 day. The circumference and pain in the observation group was lower than that of the control group after 7 days postoperatively,and there was no difference in the Rasmussen score between the two groups after 1 month. The Rasmussen scores in the observation group were higher than those in the control group after 3 and 6 months postoperatively. The healing time and the time of callus formation in the observation group were shorter than those in the control group. Conclusion External fixation at first stage combined with intramedullary nailing internal fixation at second stage has better therapeutic effect on treating open fracture of tibial shaft.