跟骨牵引辅助经皮锁定钢板内固定治疗胫腓骨远端骨折的临床效果

The clinical application of bone traction in the treatment of distal fractures of tibia and fibula fracture with minimally invasive percutaneous locking plate

目的探讨术前跟骨牵引在经皮锁定钢板内固定治疗胫腓骨骨折远端骨折的临床应用效果。方法分析阜阳市人民医院骨科2013年1月—2017年12月收治的胫腓骨骨折患者46例,根据术前固定方式的不同,可以分为跟骨牵引组20例和常规石膏外固定组26例,分别计算手术时间、出血量,随访观察患者术后骨折愈合时间及并发症,胫骨骨折Johner-Wruhs评分和踝关节功能AOFAS评分。结果所有患者均获得完整随访,随访时间6~12个月,平均(8.0±2.3)个月。所有患者伤口均一期闭合,无伤口感染发生,无伤口皮肤坏死、钢板外露。与石膏固定组比较,可缩短手术时间(8.0±2.5)min,差异具有统计学意义(P<0.05),但对骨折愈合时间、出血量没有明显影响(均P>0.05)。根据胫骨Johner-Wruhs评分标准,观察组患者中优13例,良5例,可2例,对照组患者优15例,良8例,可3例,2组患者的优良率差异无统计学意义(P>0.05);术后踝关节功能根据AOFAS评标准,观察组患者优12例,良7例,可1例,对照组患者中优14例,良10例,可2例,2组患者的优良率比较差异无统计学意义(P>0.05)。结论跟骨牵引辅助经皮锁定钢板内固定治疗胫腓骨骨折远端骨折可以相对缩短手术时间和提高复位质量,从一定程度上降低手术的难度。

Objective To explore the clinical effect of bone traction in the treatment of distal fractures of tibia and fibula fracture with minimally invasive percutaneous locking plate. Methods From January, 2013 to December, 2017, there were 46 cases with distal fractures of tibia and fibula fracture treated in the department of orthopedics in Fuyang people＇ s hospital. According to the different methods of preoperative fixation, they can be divided into calcanea] traction group （ 20 cases） and conventional plaster external fixation group （ 26 cases）. Furthermore, operation time, blood loss was calculated, and the patients were followed up for fracture healing time and postoperative complications, tibia fracture Johner- Wrnhs AOFAS rating score and ankle function. Results All patients were followed up for 6 to 12 months, with an aver- age of （ 8.0 ± 2.3 ） months. All patients had a closed wound, no wound infection occurred, no wound skin necrosis, nor exposed steel plate. Compared with the gypsum fixation group, the operation time could be shortened by （ 8.0 ±2.5 ） minutes, with significant difference （ P 〈 0. 05 ） , but no significant effect on the time of fracture healing and bleeding amount （P 〉 0. 05 ）. According to shin Johner-Wruhs scoring criteria, 15 optimal cases, 8 improved cases, 3 acceptable cases in observation group and 13 optima] cases, 5 improved cases, 2 acceptable cases in control group, without statisti- cal difference between the groups （ P 〉 0.05 ） ; according to AOFAS rating standards, the ankle joint function after surgery included 14 optimal cases, 10 improved cases, 2 acceptable cases in the observation group, and 12 optimal cases, 7 improved cases, and 1 acceptable case in the control group, with no statistical difference between the two groups （P 〉 0. 05 ）. Conclusion The treatment of distal fracture of tibia fibula fracture can shorten the operation time and improve the quality of reduction of the distal fracture of tibia fibula fracture with bone traction assisted percutaneous locking plate, which can reduce the difficulty of the operation.