转换Taylor空间支架治疗胫腓骨骨折单臂外固定术后对位不良

Transformed Taylor spatial frame for postoperative malalignment of tibiofibula fracture after unilateral external fixation

[目的]介绍应用Taylor空间支架(TSF)调整胫腓骨骨折单臂外固定架术后对位不良的手术经验。[方法]回顾性分析2016年8月~2017年8月本科收治的胫腓骨骨折单臂外固定架术后对位不良患者11例。转换TSF前所有患者复查X线片,发现不同程度的移位、成角、旋转畸形,其中2例为向前成角,5例为向后成角,内翻畸形2例,外翻畸形1例,内旋畸形1例。转换后拍摄小腿正侧位X线片,获取安装和畸形参数。将数据输入计算机配套软件获取调整数据。调整后再次摄片,如合并软组织损伤则转换后二期处理。[结果]经TSF调整所有病例均获得解剖复位。11例患者均获得12~16个月随访,骨折均愈合,无骨外露及软组织问题,固定针无松动,针道无感染。术后参照Johner-Wruhs评分表评价:优9例,良1例,可1例,优良率90.91%。[结论]采取转换TSF治疗胫腓骨骨折单臂外固定架术后对位不良是一种微创、经济、有效的治疗方式。

[Objective]To introduce the surgical technique of transformed Taylor spatial frame(TSF)for postoperative malalignment of tibiofibular fracture after unilateral external fixation.[Methods]We retrospectively reviewed 11 patients who suffered from postoperative malalignment of tibiofibular fracture after unilateral external fixation and were surgically treated from August 2016 to August 2017 in our hospital.Based on X-rays taken on all the patients before the TSF converted,various displacements were found,including angulation and rotation deformity.Among them,2 cases were of forward angulation deformity,5 cases of backward angulation deformity,2 cases of varus deformity,1 case of valgus deformity and 1 case of internal rotation deformity.The anteroposterior and lateral X-rays of the lower extremity were taken after conversion of the frame to get the installation and malformed parameters,and then input the data into the computer software to obtain the adjustment data.After adjustment by the TSF the X-rays were taken again.Secondary treatment measures were taken after conversion in cases of soft tissue injury.[Results]As adjustment by TSF finished,anatomic reduction of the fracture was achieved in all the patients.The followed up period lasted for 6~12 months.All fractures got bony healing without bone exposure or soft tissue problems.No pin loosening or pin tract infection were found in anyone of them.According to Johner-Wruhs criteria,the clinical outcomes were graded as excellent in 9 cases,good in 1 case and fair in 1 case,with excellent rate of 91%.[Conclusion]The transformed Taylor spatial frame is a minimally invasive,economical and effective treatment for postoperative malalignment of tibiofibular fracture after unilateral external fixation.