锁定钢板外置联合膜诱导技术治疗胫骨开放粉碎性骨折伴骨缺损

Locking plate external fixation combined with membrane induction technology for the treatment of open and comminuted tibial fractures with bone defects

目的:探讨锁定钢板外置联合膜诱导技术治疗胫骨开放粉碎性骨折伴骨缺损的临床疗效。方法:自2018年1月至2019年7月将收治的胫骨开放粉碎性骨折伴骨缺损患者92例按照治疗方法不同分为外固定组和内固定组,每组46例。外固定组男29例,女17例;年龄25~62(37.45±10.92)岁;AO分型A型15例,B型22例,C型9例;Gustilo分型Ⅱ型21例,ⅢA型10例,ⅢB型10例,ⅢC型5例;予骨折复位锁定钢板外置固定术治疗。内固定组男31例,女15例;年龄23~60(36.88±10.64)岁;AO分型A型18例,B型20例,C型8例;Gustilo分型Ⅱ型22例,ⅢA型11例,ⅢB型7例,ⅢC型6例;予传统切开复位钢板内固定术治疗。记录并比较两组患者手术时间、术中出血量、切口长度、住院时间、骨折愈合时间以及下肢完全负重时间和并发症情况,并于术前和术后1个月比较骨密度、骨钙素、血钙及血磷水平。结果:所有患者获得随访,时间12~18(14.92±2.46)个月。外固定组手术时间、术中出血量、切口长度、住院时间、骨折愈合时间、下肢完全负重时间明显优于内固定组(P<0.05)。术后1个月外固定组骨密度、骨钙素、血钙、血磷水平均明显高于内固定组(P<0.05)。外固定组发生并发症4例,内固定组发生并发症13例,外固定组术后并发症发生率(8.70%)明显低于内固定组(28.26%)(χ^(2)=4.618,P=0.032)。结论:锁定钢板外置联合膜诱导技术治疗胫骨开放性并粉碎性骨折伴严重创伤后骨缺损,具有创伤小、固定可靠、骨折愈合时间短等优点,可改善骨代谢活性且术后并发症少。

Objective:To explore clinical effect of locking plate external fixation combined with membrane induction technology in treating open and comminuted tibial fractures with bone defects.Methods:Totally 92 patients of open and comminuted tibial fractures with bone defects were chosen form January 2018 to July 2019,and randomly divided into external fixation group and internal fixation group,46 patients in each group.In external fixation group,there were 29 males and 17 females,aged from 25 to 62 years old,with an average of(37.45±10.92)years old;according to AO classification,15 patients were type A,22 patients were type B and 9 patients were type C;according to Gustilo classification,21 patients were typeⅡ,10 patients were typeⅢA,10 patients were typeⅢB,5 patients were typeⅢC;treated by fracture reduction with locking plate external fixation.In internal fixation group,there were 31 males and 15 females,aged from 23 to 60 years old,with an average of(36.88±10.64)years old;according to AO classification,18 patients were type A,20 patients were type B and 8 patients were type C;according to Gustilo classification,22 patients were typeⅡ,11 patients were typeⅢA,7 patients were typeⅢB,6 patients were typeⅢC;treated by traditional open reduction with plate internal fixation.Operation time,intraoperative blood loss,incision length,hospital stay,fracture healing time and lower limb full weight-bearing time and postoperative complications between two groups were observed and compared,bone mineral density,osteocalcin,blood calcium and phosphorus before operation and 1 month after operation.Results:All patients were followed up from 12 to 18 months with an average of(14.92±2.46)months.Operation time,intraoperative blood loss,incision length,hospital stay,fracture healing time and lower limb full weight-bearing time of external fixation group were significantly better than that of internal fixation group(P<0.05).Postoperative bone mineral density,osteocalcin,blood calcium and phosphorus at 1 month in external group were higher than that of internal fixation group(P<0.05).Four patients in external fixation group occurred complications,13 patients in internal fixtaion group,and occurrence rate of complications in external fixation group(8.70%)was lower than that of internal fixtaion group(28.26%)(χ^(2)=4.618,P=0.032).Conclusion:Locking plate external fixation combined with membrane induction technology in treating open and comminuted tibial fractures with severe post-traumatic bone defects has advantages of less trauma,reliable fixation,shorter fracture healing time,and could improve bone metabolic activity with less postoperative complications.