Ilizarov技术联合皮瓣修复治疗胫腓骨骨折合并软组织缺损的临床价值

Clinical Value of Ilizarov Technique Combined with Flap Repair in the Treatment of Tibiofibular Fracture with Soft Tissue Defect

目的探讨Ilizarov技术联合皮瓣修复治疗胫腓骨骨折合并软组织缺损的临床价值。方法选取2016年2月—2019年2月收治的胫腓骨骨折合并软组织缺损108例。根据手术方式分为观察组56例和对照组52例。对照组行皮瓣修复联合Ilizarov骨搬运术,观察组行Ilizarov骨短缩-延长联合皮瓣修复术。记录2组围术期指标,包括住院时间、术中出血量、愈合时间及创面闭合时间。分别在术前、术后3 d检测2组血清醛固醇(ALD)、皮质醇(Cor)、肾上腺素(E)、去甲肾上腺素(NE)水平。术后随访12个月,比较2组临床效果,利用Kofoed踝关节评价系统分别于术前、术后3、6、12个月评估踝关节功能,并分析2组术后并发症发生情况。结果观察组住院时间、愈合时间、创面闭合时间短于对照组(P<0.01)。2组术后3 d血清ALD、Cor、E、NE水平均高于术前,观察组低于对照组(P<0.05,P<0.01)。2组术后3、6、12个月Kofoed评分高于术前,且观察组高于对照组(P<0.05,P<0.01)。2组愈合优良率和并发症发生率比较差异无统计学意义(P>0.05)。结论胫腓骨骨折并软组织缺损患者行Ilizarov骨短缩-延长联合皮瓣修复术,能缩短住院、愈合、创面闭合时间,且可减轻术后应激反应,促进局部功能恢复,总体疗效理想。

Objective To explore the value of Ilizarov technique combined with flap repair in the treatment of tibiofibular fracture with soft tissue defect.Methods A total of 108 cases of tibiofibular fracture with soft tissue defect treated from February 2016 to February 2019 were enrolled in this study.According to the operation method,they were divided into observation group(n=56)and control group(n=52).The control group received flap repair combined with Ilizarov,and the observation group received Ilizarov bone shortening-lengthening combined with flap repair.The perioperative indexes of the two groups were recorded,including length of hospitalization,intraoperative bleeding volume,healing time and wound closure time.The levels of aldosterol(ALD),cortisol(Cor),epinephrine(E)and norepinephrine(NE)in the serum of the two groups were measured before and at 3 days after operation respectively.At 12-months follow-up,clinical effect of the two groups was compared.Using the Kofoed ankle joint evaluation system,ankle joint function was evaluated before operation,at 3,6 and 12 months after operation respectively,and postoperative complications of the two groups were analyzed.Results The length of hospitalization,healing time and wound closure time of the observation group were significantly shorter than those of the control group(P<0.01).The levels of ALD,Cor,E and NE in the two groups were significantly higher than those before operation,and the levels in the observation group were still significantly lower than that in the control group(P<0.05,P<0.01).At 3,6 and 12 months after operation,the Kofoed scores of the two groups were significantly higher than those of the control group(P<0.05,P<0.01).There was no significant difference in the good rate of healing and incidence of complications between the two groups(P>0.05).Conclusion Ilizarov combined with flap repair can shorten the length of hospitalization,time of healing and wound closure,reduce postoperative stress response,and promote local functional recovery,with a satisfactory overall effect.