[1]张伟业,万春友,张涛,等.外固定器轴向载荷分担比测试在Taylor空间支架外固定治疗胫腓骨开放性骨折中的应用[J].中医正骨,2019,31(10):21-25.
　ZHANG Weiye,WAN Chunyou,ZHANG Tao,et al.Application of axial load sharing ratio test on external fixator to the surgery of Taylor spatial frame external fixation for treatment of open tibiofibular fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(10):21-25.
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外固定器轴向载荷分担比测试在Taylor空间支架外固定治疗胫腓骨开放性骨折中的应用()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期数:
2019年10期
页码:
21-25
栏目:
外固定技术
出版日期:
2019-10-20

文章信息/Info

Title:
Application of axial load sharing ratio test on external fixator to the surgery of Taylor spatial frame external fixation for treatment of open tibiofibular fractures
作者:
张伟业1; 万春友2; 张涛2; 王明杰2; 刘钊2; 张宁宁2; 赵远航1
(1.天津中医药大学研究生院,天津 301617; 2.天津市天津医院,天津 300211)
Author(s):
ZHANG Weiye1; WAN Chunyou2; ZHANG Tao2; WANG Mingjie2; LIU Zhao2; ZHANG Ningning2; ZHAO Yuanhang1
1.Graduate college of Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China 2.Tianjin Hospital,Tianjin 300211,China
关键词:
胫骨骨折;  骨折; 开放性;  骨折固定术;  生物力学;  Taylor空间支架;  轴向载荷
Keywords:
tibial fractures;  fractures; open;  fracture fixation;  biomechanics;  Taylor spatial frame;  axial load
摘要:
目的:探讨外固定器轴向载荷分担比测试在Taylor空间支架外固定治疗胫腓骨开放性骨折中的应用价值。方法:胫腓骨开放性骨折患者60例,按照入组顺序随机分为力学测试组和常规方法组,每组30例。2组患者均由同一组医师行TSF外固定手术治疗。力学测试组患者于术后12周X线片显示骨折端有连续性骨痂连接时,开始行外固定器轴向载荷分担比测试,每2周测试1次。当外固定器轴向载荷分担比为5%～10%时,每日在非完全负重下松开TSF的6根连接杆上的各个关节,患者扶拐活动30 min给骨折断端加压,然后在完全负重下紧固TSF各关节。当外固定器轴向载荷分担比<5%时,松开TSF各关节,在每日锻炼30 min的基础上适度增加锻炼时间,锻炼后不再紧固TSF各关节,即模拟拆架。模拟拆架2周后,外固定器轴向载荷分担比仍<5%、X线片示骨折端无移位,且患者局部无疼痛、热、肿等表现时,拆除TSF。常规方法组患者术后按照常规方法,根据骨折愈合时间、影像学检查结果以及临床医师经验评价骨折愈合程度,骨折达到临床愈合标准时拆除TSF。记录2组患者的TSF固定时间、骨折愈合时间,随访观察并发症发生情况。结果:2组患者均获随访,随访时间4～13个月,中位数8个月。力学测试组患肢轴向载荷分担比降至5%～10%的时间为(19.57±1.95)周、降至5%以下的时间为(23.07±2.26)周,TSF固定时间短于常规方法组[(24.67±1.42)周,(33.47±2.63)周; t=15.851,P=0.000]。2组患者骨折均愈合,力学测试组骨折愈合时间短于常规方法组[(20.90±2.48)周,(31.2±2.79)周; t=14.869,P=0.000]。力学测试组术后发生针道感染2例、骨折延迟愈合2例(愈合时间分别为30周、32周),常规方法组术后并发针道感染3例、骨折延迟愈合4例(愈合时间分别为37周、37周、40周、41周),针道感染者均经换药等处理后针道愈合; 均未发生外固定架松动、断裂及骨折移位、再骨折等并发症; 2组患者并发症发生率比较,差异无统计学意义(χ2=1.002,P=0.317)。结论:采用TSF外固定治疗胫腓骨开放性骨折,术后根据外固定器轴向载荷分担比的测试结果逐步拆除外固定架,可缩短TSF固定时间和骨折愈合时间,安全可靠。
Abstract:
Objective:To explore the applied values of axial load sharing ratio test on external fixator in the surgery of Taylor spatial frame(TSF)external fixation for treatment of open tibiofibular fractures.Methods:Sixty patients with open tibiofibular fractures were selected and randomly divided into mechanical test group and conventional method group according to their enrolled sequence,30 cases in each group.The surgeries of TSF external fixation were performed on patients in the 2 groups by the same group of surgeons.The axial load sharing ratio tests were performed on patients in mechanical test group when continuous bony callus were found at the broken ends on X-ray films at 12 weeks after the surgery.The tests were performed every other week.The joints on the 6 connecting rods of TSF were loosened every day under the premise of partial weight-bearing when the axial load sharing ratio reached 5%-10%,and the patients were asked to walk with crutches for 30 minutes for compressing the broken ends,and then all joints of TSF were tightened under the premise of full weight-bearing.The joints on the 6 connecting rods of TSF were loosened when the axial load sharing ratio was<5%,and the everyday exercise time was moderately increased.After the exercises,the joints of TSF were no longer tightened,in other words,the simulated removal of TSF was performed.After 2-week simulation,the TSF was removed when the axial load sharing ratio was<5% and no displacement of broken ends on X-ray films and regional pain,heat and swelling were found.The TSFs were removed from patients in conventional method group when the fracture healing reached the clinical healing standards according to fracture healing time,imaging examination results and experience of clinicians.The TSF fixation time and fracture healing time were recorded and compared between the 2 groups.The patients were followed up and the complication incidences were observed and compared between the 2 groups.Results:All patients in the 2 groups were followed up for 4-13 months with a median of 8 months.The axial load sharing ratio of TSF decreased to 5%-10% in 19.57+/-1.95 weeks and decreased to<5% in 23.07+/-2.26 weeks respectively in mechanical test group.The TSF fixation time was shorter in mechanical test group compared to conventional method group(24.67+/-1.42 vs 33.47+/-2.63 weeks,t=15.851,P=0.000).All fractures healed in the 2 groups,and the fracture healing time was shorter in mechanical test group compared to conventional method group(20.90+/-2.48 vs 31.2+/-2.79 weeks,t=14.869,P=0.000).The postoperative pin hole infection was found in 2 patients in mechanical test group and 3 patients in conventional method group,and the delayed union of fracture was found in 2 patients(the fracture healing time was 30 and 32 weeks repectively)in mechanical test group and 4 patients(the fracture healing time was 37,37,40 and 41 weeks repectively)in conventional method group.The pin hole healed after dressing change.No complications such as loosening or breakage of external fixators,fracture displacement and refracture were found in the 2 groups.There was no statistical difference in complication incidences between the 2 groups(χ2=1.002,P=0.317).Conclusion:Gradual TSF removal under the guidance of axial load sharing ratio test on TSF can shorten TSF fixation time and fracture healing time in treatment of open tibiofibular fractures,and it is safe and reliable.

参考文献/References:

[1] PENN-BARWELL J G,BENNETT P M,FRIES C A,et al.Severe open tibial fractures in combat trauma:management and preliminary outcomes[J].Bone Joint J,2013,95-B(1):101-105.
[2] MANGUKIYA H J,MAHAJAN N P,PAWAR E D,et al.Functional and radiological outcome in management of compound tibia diaphyseal fracture with AO monolateral fixator versus Limb reconstruction system[J].J Orthop,2018,15(1):275-281.
[3] UZEL A P,LEMONNE F,CASOLI V.Tibial segmental bone defect reconstruction by Ilizarov type bone transport in an induced membrane[J].Orthop Traumatol Surg Res,2010,96(2):194-198.
[4] YE D,XU Y,ZHANG H,et al.Effects of low-dose microwave on healing of fractures with titanium alloy internal fixation:an experimental study in a rabbit model[J].PLoS One,2013,8(9):e75756. 中医正骨2019年10月第31卷第10期 J Trad Chin Orthop Trauma,2019,Vol.31,No.10(总745) (总746)中医正骨2019年10月第31卷第10期 J Trad Chin Orthop Trauma,2019,Vol.31,No.10
[5] 葛启航,万春友,刘亚北,等.胫腓骨开放骨折Taylor空间支架外固定术后轴向应力刺激对骨折愈合的影响研究[J].中国修复重建外科杂志,2017,31(8):931-935.
[6] 马继海,张涛,海碧霞,等.骨外固定动力化治疗开放性胫腓骨骨折[J].中国修复重建外科杂志,2018,32(2):174-177.
[7] LEE C K,CHUA Y P,SAW A.Antimicrobial gauze as a dressing reduces pin site infection:a randomized controlled trial[J].Clin Orthop Relat Res,2012,470(2):610-615.
[8] 雍炜,曹海鲲,赵远航,等.轴向载荷分担比指导外固定器动力化的临床应用[J].中国中西医结合外科杂志,2019,25(1):13-17.
[9] RÜEDI T P,BUCKLEY R E,MORAN C G.骨折治疗的AO原则[M].危杰,刘璠,吴新宝,等译.2版.上海:上海科学技术出版社,2010:53-62.
[10] GUSTILO R B,MENDOZA R M,WILLIAMS N.Problems in the management of type Ⅲ(severe)open fractures:a new classification of type Ⅲ open fractures[J].J Trauma,1984,24(8):742-746.
[11] 万春友,金鸿宾,张金利,等.胫腓骨复杂骨折固定研究进展[J].中国矫形外科杂志,2009,17(12):918-920.
[12] SHARMA H,NUNN T.Conversion of open tibial Ⅲb to Ⅲa fractures using intentional temporary deformation and the Taylor Spatial Frame[J].Strategies Trauma Limb Reconstr,2013,8(2):133-140.
[13] 刘钊,万春友,张涛,等.轴向载荷分担比测试辅助Taylor空间支架治疗胫腓骨骨折的作用[J].中华创伤杂志,2019,35(4):348-353.
[14] AARNES G T,STEEN H,LUDVIGSEN P,et al.In vivo assessment of regenerate axial stiffness in distraction osteogenesis[J].J Orthop Res,2005,23(2):494-498.
[15] 武富良,柴占京,李振龙.3种固定方法治疗开放性胫骨骨折[J].中医正骨,2015,27(3):46-48.
[16] REN T,DING L,XUE F,et al.Risk factors for surgical site infection of pilon fractures[J].Clinics,2015,70(6):419-422.
[17] HENDERSON D J,RUSHBROOK J L,HARWOOD P J,et al.What are the biomechanical properties of the taylor spatial frame?[J].Clin Orthop Relat Res,2017,475(5):1472-1482.
[18] 葛启航,万春友,邵醒,等.Taylor空间支架结合计算机辅助闭合复位在胫腓骨骨折中的应用研究[J].中国修复重建外科杂志,2019,33(2):144-148.
[19] 张宁宁,万春友,张涛,等.Taylor空间支架治疗胫腓骨中下段骨折疗效观察[J].中国修复重建外科杂志,2018,32(8):1012-1017.
[20] ZENIOS M.The use of the taylor spatial frame for the treatment of unstable tibial fractures in children[J].J Orthop Trauma,2013,27(10):563-568.
[21] MANNER H M,HUEBL M,RADLER C,et al.Accuracy of complex lower-limb deformity correction with external fixation:a comparison of the Taylor Spatial Frame with the Ilizarov ring fixator[J].J Child Orthop,2007,1(1):55-61.
[22] 张洪亮,万春友,张涛,等.转换Taylor空间支架治疗胫腓骨骨折单臂外固定术后对位不良[J].中国矫形外科杂志,2019,27(14):1316-1320.
[23] 曹海鲲,万春友,姚辉,等.计算机辅助Taylor空间支架治疗开放性胫腓骨骨折[J].中国矫形外科杂志,2019,27(4):331-335.
[24] 刘彦士,张弢,马信龙,等.轴向载荷分担比例评价骨愈合刚度及其指导骨外固定器安全拆除时机[J].中华创伤骨科杂志,2016,18(12):1050-1056.
[25] 卢庆威,万春友,张弢,等.轴向载荷力学测试在胫腓骨骨折术后外固定器拆除中的临床应用[J].中国修复重建外科杂志,2016,30(9):1085-1088.

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备注/Memo

备注/Memo:
通讯作者:万春友 E-mail:wanchunyouxs@163.com(收稿日期:2019-08-01 本文编辑:杨雅)
更新日期/Last Update: 2019-10-15