[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.

参考文献/References:

[1] 张文举,滕勇.胫骨远端骨折手术治疗的研究进展[J].中国医学装备,2014,28(9):138-140.
[2] JAVDAN M,TAHRIRIAN M A,NOURI M.The role of fibular fixation in the treatment of combined distal tibia and fibula fracture:a randomized,control trial[J]. Adv Biomed Res,2017,6:48-53.
[3] WU K,LIN J,HUANG J,et al.Evaluation of transsyndesmotic fixation and primary deltoid ligament repair in ankle fractures with suspected combined deltoid ligament injury[J].J Foo Ankle Surg,2018,57(4):694-700.
[4] 郑天伟.腓骨闭合复位弹性钉内固定在胫腓骨骨折治疗中的临床效果及对并发症、日常生活能力的影响[J].中国社区医师,2019,35(20):33.
[5] GIUSCA S,RAUPP D,DREYER D,et al.Successful endovascular treatment in patients with acute thromboembolic ischemia of the lower limb including the crural arteries[J].World J Cardiol,2018,10(10):145-152.
[6] WILKE B,HOUDEK M,RAO R R,et al.Treatment of unicameral bone cysts of the proximal femur with internal fix-ation lessens the risk of additional surgery[J].Orthopedics,2017,40(5):862-867.
[7] 郭悦,董鑫宇,苏秀云,等.六自由度并联机器人模拟中医正骨手法复位简单骨折的可行性研究[J].中医正骨,2020,32(7):1-5.
[8] 吴开元,曾昭池,朱志勇,等.胫骨远端髓内钉与胫骨远端锁定接骨板治疗胫腓骨远端骨折的疗效[J].贵州医科大学学报,2018,43(6):716-720.
[9] 吴天然,陈夏平,李铭雄,等.微创孟氏架外固定治疗老年股骨顺转子间骨折的临床研究[J].中医正骨,2016,28(5):5-8.
[10] 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,2010:624-625.
[11] HSIEH Y W,HSUEH I P,CHOU Y T,et al.Development and validation of a short form of the Fugl-Meyer motor scale in patients with stroke[J].Stroke,2007,38(11):3052-3504.
[12] PAGE S J,LEVINE P,HADE E.Psychometric properties and administration of the wrist/hand subscales of the Fugl-Meyer assessment in minimally impaired upper extremity hemiparesis in stroke[J].Arch Phys Med Rehabil,2012,93(12):2373-2376.
[13] 严广斌.AOFAS踝-后足评分系统[J].中华关节外科杂志(电子版),2014,8(4):557.
[14] 陈雪,张展榕,邓子翔,等.老年骨质疏松性踝关节骨折切开复位固定的疗效[J].中华创伤杂志,2020,36(1):39-44.
[15] JOHNER R,WRUHS O.Classification of tibial shaft fractures and correlation with results after rigid internal fix-ation[J].Clin Orthop Relat Res,1983(178):7-25.
[16] 周果.微创锁定钢板内固定与闭合复位交锁髓内钉应用于胫腓骨中下段骨折的效果对比分析[J].医学理论与实践,2019,32(5):699-700.
[17] 张涛,万春友,赵远航,等.骨痂力学测试在胫腓骨骨折支架外固定术后骨折愈合评价中的应用价值[J].中医正骨,2019,31(10):26-30.
[18] 赵远航,万春友,张涛,等.Taylor空间支架外固定治疗闭合性胫腓骨骨折合并膝内翻畸形[J].中医正骨,2019,31(10):60-62.
[19] ZHANG X N,SUN X Y,MENG X L,et al.Risk factors for medical complications after long-level internal fixation in the treatment of adult degenerative scoliosis[J].Int Orthop,2018,42(9):2603-2612.
[20] NOURAEI M,MOTIFIFAR M,BARAZANDEH M.Evalu-ation of outcomes of open reduction and internal fixation surgery in patients with type c distal humeral fractures[J].Adv Biomed Res,2018,7:3.
[21] 刘杰.组合式外固定架固定治疗胫腓骨远端骨折的效果观察[J].中国实用医刊,2019,46(7):74-77.
[22] 余新平,刘康,王金军,等.腓骨后外侧入路联合微创经皮钢板内固定技术治疗胫腓骨远端A3型骨折[J].中华创伤骨科杂志,2017,19(3):207-212.
[23] BOFFELI T J,COLLIER R C,GERVAIS S J.Two-view gravity stress imaging protocol for nondisplaced typeⅡsupination external rotation ankle fractures:introducing the gravity stress cross-table lateral view[J].J Foot Ankle Surg,2017,56(4):898-904.
[24] 董磊,荆珏华,王宏亮.跟骨牵引辅助经皮锁定钢板内固定治疗胫腓骨远端骨折的临床效果[J].中华全科医学, 2018,16(9):1438-1440.
[25] YE C,LAI Q,ZHANG S,et al.Osteopoikilosis found incidentally in a 17-year-old adolescent with femoral shaft fracture:a case report[J].Medicine(Baltimore),2017,96(47):e8650.

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