早期清创切开复位联合内外固定对胫腓骨开放性骨折的治疗效果

Effect of early debridement and open reduction combined with internal and external fixation on open fracture of tibia and fibula

目的探讨早期清创切开复位联合内外固定对胫腓骨开放性骨折的治疗效果。方法回顾性分析2017年6月—2018年5月中国人民解放军联勤保障部队第九○一医院收治的82例胫腓骨开放性骨折患者的临床资料,其中男性42例,女性40例;年龄(34.8±16.1)岁,年龄范围20~62岁。根据手术方式不同分为对照组(n=32)和观察组(n=50),对照组患者接受早期清创有限内固定治疗,观察组患者接受早期清创切开复位联合内外固定治疗。观察两组手术时间、失血量、愈合时间、术后红细胞沉降率(ESR)、C反应蛋白(CRP)水平、白细胞计数(WBC)、治疗优良率及并发症发生率。计量资料采用均数±标准差(Mean±SD)表示,组间比较采用独立样本t检验;计数资料采用百分比(%)表示,组间比较采用χ^2检验。结果观察组手术时间(98.35±15.14)min高于对照组(79.26±13.22)min,失血量(120.53±41.66)mL及愈合时间(16.84±5.07)min均显著低于对照组[(210.59±56.60)mL、(19.48±5.46)min],差异具有统计学意义(t=5.85、7.76、2.20,P<0.05)。观察组术后ESR(18.91±2.70)mm/h、CRP(39.20±3.13)ng/L、WBC(7.04±1.12)×10^3/L水平显著低于对照组[(27.36±3.28)mm/h、(45.63±4.06)ng/L、(11.06±1.51)×10^3/L],差异具有统计学意义(t=12.17、7.63、12.95,P<0.05)。观察组优良率虽高于对照组,但两组比较差异无统计学意义(P>0.05)。观察组并发症发生率6.00%(3/50)显著低于对照组的31.25%(10/50),差异具有统计学意义(P<0.05)。结论早期清创切开复位联合内外固定是治疗胫腓骨开放性骨折的有效方法,相较于有限内固定而言具有愈合时间短、失血量少、并发症发生率低等优势,且降低患者炎症反应。

Objective To investigate the effect of early debridement and open reduction combined with interal and external fixation on open fracture of tibia and fibula.Methods The elinical data of 82 patients with open tibiofibular fractures admitted to the 901st Hospital of the Joint Logistie Support Force of the Chinese People's Liberation Army from June 2017 to May 2018 were retrospectively analyzed.There were 42 males and 40 females,aged 20-62 years,with an average age(34.8±16.1)years.According to different surgical methods,they were divided into control group(n=32)and observation group(n=50).The patients in the control group received early debridement and limited internal fixation,the patients in the observation group received early debridement and open reduction combined with internal and external fixation.The operation time,blood loss,healing time,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)level,white blood cell count(WBC),excellent rate and complication rate were observed in both groups.The measurement data were expressed as mean±standard deviation(Mean±SD),comparison between groups was analyzed using independent samplet test,count data were expressed as percentage(%),comparison between groups was performed using chi-square test.Results The operative time(98.35±15.14)min in the observation group were higher than those in the control group(79.26±13.22)min,blood loss(120.53±41.66)mL and healing time(16.84±5.07)min in the observation group were significantly lower than those in the control group[(79.26±13.22)min,(210.59±56.60)mL,(19.48±5.46)min].The difference was statistically significant(1 values were 5.85,7.76,2.20,P<0.05).Compared with control group,the level of ESR(18.91±2.70)mm/h,CRP(39.20±3.13)ng/L,WBC(7.04±1.12)x 10^3/L were signifcantly lower than control group[(27.36±3.28)mm/h,(45.63±4.06)ng/L,(11.06±1.51)x10^3/L].The difference was statistically significant(1 values were 12.17,7.63,12.95,P<0.05).Compared with control groups's excellent and good rate,the excellent and good rate of observation group was higher,but the difference was not statistically significant(P>0.05).The incidence of complications in the observation group(6.00%,3/50)was signifieantly lower than that in the control group(31.25%,10/50)(P<0.05).Conclusions Early debridement and open reduction combined with internal and external fixation is an effective method for the treatment of open fracture of tibia and fibula.Compared with internal fixation,it has the advantages of shorter healing time,less blood loss and lower ineidence of complications.And it can also reduce the inflammatory response of patients.