新型三维外固定架系统联合内固定治疗GustiloⅢ型胫腓骨开放性骨折的疗效分析

Efficacy analysis of a new three-dimensional external fixator system combined with internal fixation in the treatment of Gustilo Ⅲ type open tibiofibular fractures

目的探讨一期新型三维创伤外固定架系统联合二期内固定治疗Gustilo Ⅲ型胫腓骨开放性骨折的临床效果。方法收集中国人民解放军联勤保障部队第989医院自2018年6月至2020年1月间收治的40例Gustilo Ⅲ型胫腓骨开放性骨折的患者作为研究对象,随机分为观察组和对照组。观察组(20例)一期采用三维创伤外固定架系统固定骨折,二期采用适当内固定治疗。对照组(20例)一期清创后,予以石膏或支具辅助固定,二期采用适当内固定治疗。对比两组术后并发症、骨折愈合情况及下肢功能康复效果。结果观察组骨折愈合率为95.0%,对照组骨折愈合率为90.0%,两组比较差异无统计学意义(>0.05)。观察组骨折愈合时间平均(16.50±0.68)周,对照组平均(18.78±4.60)周,两组比较差异有统计学意义(<0.05)。观察组术后住院时间平均(30.20±4.67)d,对照组平均(33.35±3.88)d,两组比较差异有统计学意义(<0.05)。观察组术后并发症共2例,对照组共9例,两组比较差异有统计学意义(<0.05)。观察组下肢功能康复评估优良率为85.0%,对照组为55%,两组比较差异有统计学意义(<0.05)。以上数据分析均显示差异具有统计学意义。结论一期新型三维外固定架系统联合内固定治疗GustiloⅢ型胫腓骨开放性骨折的手术方式其骨折平均愈合时间短,住院周期短,下肢功能康复疗效好,是一种确切的手术方式。

Objective To investigate the clinical effect of a new three-dimensional trauma external fixator system in phase Ⅰ combined with phase Ⅱ internal fixation in the treatment of open tibiofibular fractures of Gustilo Ⅲ type.Methods Forty patients with Gustilo Ⅲ tibiofibular open fractures admitted to our department from June 2018 to January 2020 were collected as study subjects and randomly divided into observation and control groups.The observation group(20 cases)was treated with a three-dimensional trauma external fixation frame system to fix the fracture in the first stage and appropriate internal fixation in the second stage.The control group(20 cases)was treated with plaster or brace assisted fixation after the first stage of debridement,and the second stage was treated with appropriate internal fixation.The postoperative complications,fracture healing and functional rehabilitation of lower limbs were compared between the two groups.Results The fracture healing rate was 95.0% in the observation group and 90.0% in the control group,and the difference between the two groups was not statistically significant(P>0.05).The mean fracture healing time was(16.50±0.68)weeks in the observation group and(18.78±4.60)weeks in the control group,and the difference was statistically significant between the two groups(P<0.05).The mean postoperative hospital stay was(30.20±4.67)days in the observation group and(33.35±3.88)days in the control group,and the difference was statistically significant between the two groups(P<0.05).There were 2 cases of postoperative complications in the observation group and 9 cases of postoperative complications in the control group with the statistical difference between the two groups(P<0.05).The excellent rate of functional rehabilitation assessment of lower limbs in the observation group was 85%,and the excellents rate of functional rehabilitation assessment of lower limbs in the control group was 55% in the comparison between the two groups(P<0.05).All of the above data analysis showed that the differences were statistically significant.Conclusion A new three-dimensional external fixation frame system combined with internal fixation in the treatment of Gustilo type Ⅲ open tibiofibular fractures is a definitive surgical approach with short average fracture healing time,short hospitalization period,and good functional rehabilitation of the lower extremity.