胫骨骨折骨痂刚度评估拆除单臂外固定架的研究

Evaluation of bone callus stiffness for unilateral external fixator removal in the treatment of tibial fractures

[目的]探讨轴向载荷分担比测试在胫骨骨折骨痂刚度评估拆除单臂外固定架的有效性。[方法]回顾性分析2017年1月—2020年7月天津市天津医院收治的49例胫骨骨折患者的临床资料,患者均于伤后2周内接受单臂外固定术。按照随机数字表法,24例术后行轴向载荷分担比测试(测试组),25例未行测试(常规组)。比较两组围手术期、随访与影像学资料。[结果]所有患者均顺利完成手术。两组手术时间、切口总长度、术中失血量、术中透视次数、下地行走时间、切口愈合情况、住院时间、外固定架调整时间的差异均无统计学意义(P>0.05)。随访时间平均(10.5±2.4)个月,随术后时间推移,两组患者VAS评分、膝屈伸ROM、踝跖屈-背伸ROM均显著改善(P<0.05),相应时间点,两组间上述指标的差异均无统计学意义(P>0.05)。测试组带架时间显著少于常规组[(198.8±36.4)d vs(315.7±51.8)d,P<0.001],两组间针道感染率、再骨折率的差异均无统计学意义(P>0.05)。影像学方面,两组骨折对位调整完成后较术后即刻显著改善(P<0.05),术后两组骨痂形成质量逐渐好转(P<0.05),在拆架时常规组骨痂形成质量显著优于测试组[优/良/差,(23/2/0)vs(13/11/0),P=0.002]。[结论]定期应用轴向载荷分担比测试能够安全及时地指导胫骨骨折单臂外固定架拆除,效果安全可靠。

[Objective]To investigate the effectiveness of axial load-sharing ratio test in assessing the rigidity of callus of tibial frac-tures for the removal of unilateral external fixator.[Methods]A retrospective study was conducted on 49 patients who were admitted to Tianjin Hospital for tibial fractures from January 2017 to July 2020.All patients received unilateral external fixator within 2 weeks after in-jury.According to random number table method,axial load sharing ratio was measured in 24 patients(the tested group),while not tested in other 25 patients(the routine group).The perioperative,follow-up and imaging data of the two groups were compared.[Results]All patients in both groups had the treatment completed successfully,without significant differences in operation time,total incision length,intraopera-tive blood loss,intraoperative fluoroscopy times,walking time,incision healing,hospital stay,and adjustment time of external fixator be-tween the two groups(P>0.05).With time of follow-up period lasted for(10.5±2.4)months on an average,the VAS score,knee flexion-ex-tension rang of motion(ROM)and ankle plantar flexion-dorsal extension ROM significantly improved in both groups(P<0.05),which were not statistically significant between the two groups at any time points accordingly(P>0.05).However,the time interval bearing the external frame in the tested group was significantly less than that in the routine group[(198.8±36.4)days us(315.7±51.8)days,P<0.001],whereas there were no significant differences in adverse events,such as incidence of pin infection and refracture between the two groups(P>0.05).As for imaging,the tibial alignment significantly improved in both groups after frame adjustment compared with that immediately after oper-ation(P<0.05),while the quality of callus formation in both groups gradually improved over time(P<0.05).However,the routine group had significantly better the quality of callus on images than the tested group at the time of frame removal[excellent/good/poor,(23/2/0)us(13/11/O),P=0.002].[Conclusion]Regular application of axial load sharing ratio test can safely and timely guide the removal of unilateral external fixator for tibial fracture,and the effect is safe and reliable.