基于损伤控制理念应用新型骨折复位牵引装置辅助微创内固定治疗胫腓骨远端骨折

Application of a new type of fracture reduction and bone traction device assisted minimally invasive percutaneous plate osteosynthesis for distal tibia and fibula fractures based one damage control orthopacedics

目的观察新型骨折复位牵引装置辅助微创钢板内固定治疗胫腓骨远端骨折的临床应用可行性与疗效。方法纳入自2019-06—2020-06诊治的31例胫腓骨远端骨折,基于损伤控制理念先采用新型骨折复位牵引装置进行骨折牵引复位,骨折良好复位固定且软组织损伤控制后可择期行微创钢板内固定手术治疗。采用制动舒适度问卷(Immobilization comfort questionnaire,ICQ)评估患者在新型骨折复位牵引装置固定后的舒适度,末次随访时采用踝与后足功能AOFAS评分系统评估疗效。结果安装新型骨折复位牵引装置后28例可拄拐辅助下床行走活动。患肢消肿时间为2~8 d,平均3.4 d。牵引第1天ICQ评分为59~81分,平均71.4分;牵引第3天ICQ评分为76~91分,平均85.4分;手术当天ICQ评分为74~90分,平均83.4分。31例均获得随访,随访时间平均14.5(12~21)个月。所有患者未出现双下肢深静脉血栓形成、褥疮、针道感染、骨髓炎、骨折不愈合、骨折畸形愈合等并发症。骨折一期愈合,愈合时间平均21.6(15~26)周。末次随访时踝与后足功能AOFAS评分结果:优17例,良10例,可4例。结论新型骨折复位牵引装置结构简单、操作方便,临床应用时患者舒适度好,其辅助微创钢板内固定治疗胫腓骨远端骨折时可获得满意的骨折复位和固定效果,患者可早期下床活动,最终可获得较好的临床疗效。

Objective To explore the clinical effect of a new type of fracture reduction and bone traction device assisted minimally invasive percutaneous plate osteosynthesis for distal tibia and fibula fractures.Methods Thirty-one cases of distal tibia and fibular fractures were included from June 2019 to June 2020.Based on the damage control orthopacedics,a new type of fracture reduction and bone traction device was used to get satisfactory reduction and fixation.With soft tissue injury recovery,all patients received minimally invasive plate internal fixation.The immobilization comfort questionnaire(ICQ)was used to evaluate the patient’comfort after reduction and traction,and AOFAS scoring system was used to evaluate the efficacy at the last follow-up.Results After satisfactory reduction and fixation,28 patients could walk with crutches.The average swelling time of limb was 3.4 days(2-8 d).The average ICQ score was 71.4(59-81),85.4(76-91)and 83.4(74-90)on the first day of traction and fixation,the third day and the operation day respectively.All patients were all followed up for 12 to 21 months,an average of 14.5 months.No related complications,such as lower limb venous thrombosis,pressure sores,needle tract infection,osteomyelitis,delayed union and deformity healing,were observed during the course of the disease.All patients received primary bone union about in 15-26 weeks(mean,21.6 weeks).Seventeen cases had excellent AOFAS score,10 cases good and 4 cases fair at the last follow-up.Conclusion The new type of fracture reduction and bone traction device with simple structure and convenient operation can offer satisfactory reduction and fixation and relatively good experience to patients.Patients can get out of bed in early period and gain satisfactory clinical effects in the treatment of distal tibia and fibula fractures.