牵引外固定对胫腓骨开放性骨折损伤控制的意义

Role of distracting external fixation in injury control of open tibiofibular fractures

[目的]探讨牵引外固定技术在胫腓骨开放性骨折初期治疗中的意义。[方法]回顾性分析本院2012年2月~2017年8月处理的96例胫腓骨开放骨折患者,其中,40例在初期治疗采用外支架牵引固定(牵引外固定组),56例采用常规外支架技术(常规外固定组),两组均二期改行内固定术。比较两组临床与影像资料。[结果]牵引外固定组初次外固定手术时间和改行内固定术的间隔时间均显著短于常规组(P<0.05)。针道感染率牵引外固定组为2.50%(1/40),而常规外固定组为16.07%(9/56),差异有统计学意义(P<0.05)。牵引外固定组二期内固定手术时间显著少于常规外固定组(P<0.05)。随访14~25个月,平均(18.26±5.56)个月。两组开始负重时间和完全负重时间,以及末次随访时膝关节ROM、踝关节ROM和VAS评分的差异均无统计学意义(P>0.05)。影像方面,两组在内固定术后残余畸形和骨折愈合时间的差异均无统计学意义(P>0.05)。[结论]对开放性胫骨骨折采用初期处理采用牵引外固定,有利于二期内固定术。

[Objective]To explore the role of distracting external fixation in injury control of open tibiofibular fractures.[Methods]A retrospective study was conducted on 96 patients who underwent surgical treatment for open tibiofibular fractures in our department from February 2012 to August 2017.For injury control,40 patients received distracting external fixation,while the remaining 56 patients had conventional external fixation in the first stage of surgical intervention,and all patients of both groups underwent internal fixation in the second stage.The clinical and radiographic documents were compared between the two groups.[Results]The distracting group proved significantly superior to the conventional group with regard to the first operation time for external fixation and the interval between the first and second operation(P<0.05).The pin tract infection was2.50%(1/40)in the distracting group,whereas 16.07%(9/56)in the conventional group,which was of statistical significance(P<0.05).The patients were follow up for 14~25 months with a mean of(18.26±5.56)months.There were no statistically significant differences between the two groups in time to return ambulation,time of full-weight bearing activity,knee and ankle ROMs,as well as VAS score at the latest follow up(P>0.05).In term of radiographic assessment,no significant differences in residual angulation in sagittal and coronal planes,and time of bony healing were found between the two groups(P>0.05).[Conclusion]The distracting external fixation in the first stage operation does facilitate the internal fixation in the second stage for open tibiofibular fractures.