[1]李国梁,王旭洋,赵建勇,等.腓骨穿针内固定联合孟氏架外固定治疗胫腓骨骨折的临床研究[J].中医正骨,2021,33(04):22-27.
 LI Guoliang,WANG Xuyang,ZHAO Jianyong,et al.A clinical study of fibular Kirschner wire internal fixation combined with Meng’s fixator external fixation for treatment of tibiofibular fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(04):22-27.
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腓骨穿针内固定联合孟氏架外固定治疗胫腓骨骨折的临床研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期数:
2021年04期
页码:
22-27
栏目:
临床研究
出版日期:
2021-04-20

文章信息/Info

Title:
A clinical study of fibular Kirschner wire internal fixation combined with Meng’s fixator external fixation for treatment of tibiofibular fractures
作者:
李国梁王旭洋赵建勇张亮于君君韩广普
(河北省沧州中西医结合医院,河北 沧州 061001)
Author(s):
LI GuoliangWANG XuyangZHAO JianyongZHANG LiangYU JunjunHAN Guangpu
Cangzhou Hospital of Integrated TCM-WM·Hebei,Cangzhou 061001,Hebei,China
关键词:
胫骨骨折 腓骨 骨折固定术 外固定器 临床试验
Keywords:
tibial fractures fibula fracture fixationinternal external fixators clinical trial
摘要:
目的:探讨腓骨穿针内固定联合孟氏架外固定治疗胫腓骨骨折的临床疗效和安全性。方法:将102例胫腓骨骨折患者随机分为2组,每组51例,分别采用单纯孟氏架外固定和腓骨穿针内固定联合孟氏架外固定治疗。记录并比较2组患者的手术时间、术中出血量、术后下床时间、住院时间、骨折愈合时间、Fugl-meyer下肢运动功能评分、美国足与踝关节协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足功能评分、综合疗效和并发症发生情况。结果:①一般指标。联合固定组患者的手术时间长于孟氏架外固定组[(129.38±19.23)min,(108.35±15.57)min,t=6.070,P=0.000]、术中出血量多于孟氏架外固定组[(198.68±25.13)mL,(169.12±24.09)mL,t=6.064,P=0.000],术后下地时间、住院时间、骨折愈合时间均短于孟氏架外固定组[(15.91±5.98)d,(19.81±5.57)d,t=3.408,P=0.001;(20.67±6.17)d,(24.71±6.98)d,t=3.097,P=0.003;(61.81±5.57)d,(69.12±5.76)d,t=6.515,P=0.001]。②Fugl-meyer下肢运动功能评分。术前2组患者Fugl-meyer下肢运动功能评分比较,差异无统计学意义[(9.98±3.75)分,(9.19±3.54)分,t=13.392,P=0.410]; 术后6个月,联合固定组患者的Fugl-meyer下肢运动功能评分高于孟氏架外固定组[(27.36±4.96)分,(24.12±4.76)分,t=9.013,P=0.011],2组患者Fugl-meyer下肢运动功能评分均高于术前(t=19.961,P=0.000; t=17.973,P=0.000)。③AOFAS踝与后足功能评分。术前2组患者AOFAS踝与后足功能评分比较,差异无统计学意义[(51.28±5.59)分,(50.64±5.26)分,t=10.437,P=0.641]; 术后6个月,联合固定组患者的AOFAS踝与后足功能评分高于孟氏架外固定组[(84.82±7.92)分,(80.05±7.76)分,t=7.481,P=0.027],2组患者AOFAS踝与后足功能评分均高于术前(t=24.708,P=0.000; t=22.404,P=0.000)。④综合疗效。术后6个月,2组患者的综合疗效比较,差异无统计学意义(Z=-1.820,P=0.069)。⑤并发症。孟氏架外固定组术后出现切口感染3例、下肢深静脉血栓2例、固定针松动2例、神经损伤1例,联合固定组术后出现切口感染2例、下肢深静脉血栓1例、固定针松动1例、神经损伤1例; 2组患者并发症发生率比较,差异无统计学意义(χ2=0.793,P=0.373)。结论:腓骨穿针内固定联合孟氏架外固定治疗胫腓骨骨折,较单纯孟氏架外固定能更好地促进下肢运动功能和踝关节功能的恢复,且住院时间短、骨折愈合快、术后下床时间早,但手术时间长、术中出血量多,且二者的综合疗效和安全性相当。
Abstract:
To explore the clinical curative effects and safety of fibular Kirschner wire(K-wire)internal fixation combined with Meng’s fixator external fixation for treatment of tibiofibular fractures.Methods:One hundred and two patients with tibiofibular fractures were randomly divided into 2 groups,51 cases in each group,and were treated with monotherapy of Meng’s fixator external fixation(monotherapy group)and combination therapy of fibular K-wire internal fixation and Meng’s fixator external fixation(combination therapy group)respectively.The operative time,intraoperative blood loss,bed rest time,hospital stays,fracture healing time,Fugl-meyer(FM)lower extremity motor subscores,American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot function scores,total clinical curative effects and complication incidence were recorded and compared between the 2 groups respectively.Results:The operative time was longer,the intraoperative blood loss was more and the bed rest time,hospital stays and fracture healing time were shorter in combination therapy group compared to monotherapy group(129.38±19.23 vs 108.35±15.57 minutes,t=6.070,P=0.000; 198.68±25.13 vs 169.12±24.09 mL,t=6.064,P=0.000; 15.91±5.98 vs 19.81±5.57 days,t=3.408,P=0.001; 20.67±6.17 vs 24.71±6.98 days,t=3.097,P=0.003; 61.81±5.57 vs 69.12±5.76 days,t=6.515,P=0.001).There was no statistical difference in FM lower extremity motor subscores between the 2 groups before the surgery(9.98±3.75 vs 9.19±3.54 points,t=13.392,P=0.410).The FM lower extremity motor subscores were higher in combination therapy group compared to monotherapy group at 6 months after the surgery(27.36±4.96 vs 24.12±4.76 points,t=9.013,P=0.011),and were higher at 6 months after the surgery compared to pre-surgery in the 2 groups(t=19.961,P=0.000; t=17.973,P=0.000).There was no statistical difference in AOFAS ankle-hindfoot function scores between the 2 groups before the surgery(51.28±5.59 vs 50.64±5.26 points,t=10.437,P=0.641).The AOFAS ankle-hindfoot function scores were higher in combination therapy group compared to monotherapy group at 6 months after the surgery(84.82±7.92 vs 80.05±7.76 points,t=7.481,P=0.027),and were higher at 6 months after the surgery compared to pre-surgery in the 2 groups(t=24.708,P=0.000; t=22.404,P=0.000).There was no statistical difference in total clinical curative effects between the 2 groups at 6 months after the surgery(Z=-1.820,P=0.069).After the surgery,incision infection(3),lower extremity deep venous thrombosis(2),K-wire loosening(2)and nerve injury(1)were found in monotherapy group; while incision infection(2),lower extremity deep venous thrombosis(1),K-wire loosening(1)and nerve injury(1)were found in combination therapy group.There was no statistical difference in complication incidences between the 2 groups(χ2=0.793,P=0.373).Conclusion:The combination therapy of fibular K-wire internal fixation and Meng’s fixator external fixation can better promote the recovery of lower extremity motor function and ankle function compared to monotherapy of Meng’s fixator external fixation in treatment of tibiofibular fractures,and it has such advantages as shorter hospital stays and bed rest time and faster fracture healing,but disadvantages as longer operative time and more intraoperative blood loss,while the two therapies are similar to each other in total clinical curative effects and safety.

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通讯作者:李国梁 E-mail:doctorlgl@163.com
更新日期/Last Update: 1900-01-01