自制软组织扩张保护器在外固定支架治疗开放性股骨、胫骨骨折手术中的应用研究

The clinical study of self-made soft tissue expansion protector in the treatment of open femoral and tibial fractures with external fixator

目的探讨自制软组织扩张保护器在开放性股骨、胫骨骨折外固定支架固定治疗中的临床应用效果。方法回顾性分析2017年9月-2021年7月收治的6例开放性股骨骨折和12例开放性胫骨骨折进行外固定支架固定治疗的病例资料,分为A、B两组。A组术中当电钻钻头及外固定支架固定螺钉钻透股骨和胫骨骨质时,应用自制的软组织扩张保护器来保护电钻钻头及外固定支架固定螺钉周围的软组织;B组术中电钻钻头及外固定支架固定螺钉直接钻透骨质。比较两组术中攻入螺钉时伤口出血量,术后外固定支架固定螺钉处渗血量、固定螺钉周围软组织红肿及感染情况、固定螺钉部位疼痛。结果18例患者均顺利完成手术,均获得随访,随访时间2~26个月。A组在术中攻入螺钉时伤口出血量,术后外固定支架固定螺钉处渗血量、固定螺钉周围软组织红肿及感染情况、固定螺钉部位疼痛方面明显小于B组,两组间对比差异有统计学意义(P<0.05)。结论自制软组织扩张保护器操作方便、安全,在开放性股骨、胫骨骨折外固定支架手术中可以起到保护软组织作用,避免电钻钻头及外固定支架螺钉对软组织的二次损伤,值得临床推广应用。

Objective To explore the clinical application and effect of self-made soft tissue expansion protector in the treatment of open femoral and tibial fractures by external fixator.Methods Six cases of open femoral fractures and 12 cases of open tibial fractures treated with external fixator from September 2017 to October 2021 were retrospectively analyzed and divided into groups A and B.The patients of group A were treated with wound debridement and external fixation of open limb external fixation bracket in emergency,The self-made soft tissue expansion protector was used to protect the soft tissue around the electric drill bit and the external fixation screw when the electric drill bit and the external fixation screw penetrated the femur and tibia;The patients of group B were treated with wound debridement and external fixation of open limb external fixation bracket in emergency.During the operation,the electric drill bit and external fixation bracket fixation screw directly penetrated the bone.The amount of wound bleeding during screw insertion,the amount of bleeding volume at the surrounding area of the fixation screw,the redness and swelling of soft tissue around the screw,pain at the fixation screw and infection of soft tissue around the fixation screw were compared between two groups.Results All 18 patients successfully completed the operation and were followed up for 2-26 months.Group A was significantly less than group B in the amount of wound bleeding when the screw was inserted during operation,the amount of blood leakage at the external fixation screw,the redness and swelling of soft tissue around the screw,the pain at the screw and the infection of soft tissue around the screw.There was significant difference between two groups(P<0.05).Conclusion The self-made soft tissue expansion protector is easy and safe to operate.It can protect the soft tissue in the operation of external fixator for open femoral and tibial fractures,avoid the secondary damage of electric drill bit and external fixator screw to the soft tissue.The self-made soft tissue expansion protector is worthy of clinical application.