轴向载荷分担比指导外固定器动力化的临床应用

Clinical Application of External Fixators Motorization Guided by Axial Load Sharing Ratio

目的:探讨轴向载荷分担比用于胫腓骨骨干骨折术后指导外固定器轴向动力化促进骨折愈合的有效性。方法:选取外固定器治疗的胫腓骨骨干骨折患者100例,随机分为观察组50例,对照组50例。观察组在轴向载荷分担比指导下行外固定器轴向动力化治疗,对照组未行动力化,随访比较两组的治疗效果。结果:所有患者均获随访,随访时间4～12个月,平均6.5个月,治疗期间所有患者均未出现外固定针断裂、松动及再骨折等并发症,观察组1例骨搬移患者轴向载荷分担比<5%,X线片显示骨折断端有连续性骨痂通过,拆除外固定器连接杆后发生移位,恢复原数值行轴向加压再动力化,现已愈合。观察组除外1例骨搬移患者,其余49例患者外固定器固定时间为[(24.4±4.7)周],骨折临床愈合时间为[(22.4±4.7)周],与对照组50例患者外固定器固定时间[(29.3±5.6)周],骨折临床愈合时间[(27.3±5.6)周]比较,显著减少(P<0.05)。结论:外固定器轴向载荷分担比指导胫腓骨骨干骨折外固定术后轴向动力化可以加速骨折愈合,但不适合骨搬移截骨端已硬化患者。

Objective To investigate the effectiveness of axial load shared in guiding the axial motorization of external fixators to promote fracture healing after the surgery of tibia and fibula diaphyseal fracture.Methods A total of 100 patients with tibia and fibula diaphyseal fractures treated with external fixator were randomly divided into observation group(n=50)and control group(n=50).The patients in observation group were treated with the external fixation axia dynamization under the guidance of axial load sharing ratio,while the patients in control group with no act.The follow-up comparison was compared between the two groups.Results All patients were followed up for 4 to 12 months with an average of 6.5 months.During the treatment period,no complications such as fracture,loosening,and refracture of the external fixation needles occurred.In the observation group,the axial load of the patient with bone removal was observed.With a sharing ratio of<5%,the X-ray showed that the broken ends of the fractures had a continuous poroma pass.After dismantling the external fixation connecting rods,they shifted.The original values were restored by axial compression and then motorized,and they have now healed.In the observation group,except for one patient with bone removal,the rest of the 49 patients had an external fixation time of(24.4±4.7)weeks,and the clinical healing time of the fracture was(22.4±4.7)weeks.In the control group,50 patients had a fixed external fixation time of(29.3±5.6)weeks,and clinical healing time of fracture was(27.3±5.6)weeks(P<0.05).Conclusion The axial load sharing ratio of external fixator guides axial motorization after external fixation of tibia and fibula diaphyseal fracture can accelerate fracture healing,but it is not suitable for bone removal of patients with hardened osteotomy end.