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
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摘要
目的探讨Taylor空间支架(Taylor spatial frame,TSF)治疗胫腓骨骨折中,术后应用计算机辅助闭合复位的临床疗效。方法回顾分析2015年1月—2017年9月采用TSF治疗的30例胫腓骨骨折合并软组织损伤患者临床资料。根据复位方式不同分为对照组(15例,TSF外固定术中采用切开复位)和试验组(15例,TSF外固定术后1～3 d采用计算机辅助闭合复位)。两组患者性别、年龄、侧别、致伤原因、骨折AO分型、受伤至手术时间等一般资料比较差异均无统计学意义(P>0.05),具有可比性。记录并比较两组手术时间、术中出血量、骨折愈合时间、拆除外固定架时间;拆除外固定架后3个月,参照Johner-Wruhs胫骨干骨折治疗最终效果评价标准评定患肢功能。结果两组患者均获随访,随访时间9～16个月,平均14个月。试验组手术时间、术中出血量、骨折愈合时间和拆除外固定架时间均显著小于对照组(P<0.05)。术后发生外固定架针道浅表感染2例(两组各1例),切口感染1例(对照组),骨折延迟愈合1例(对照组),创伤性关节炎2例(两组各1例);两组并发症发生率比较差异无统计学意义(χ~2=0.370,P=0.543)。两组患者软组织缺损创面均Ⅰ期愈合。拆除外固定架3个月后,参照Johner-Wruhs胫骨干骨折治疗最终效果评价标准评定患肢功能,试验组优3例、良9例、可2例、差1例,优良率80.0%;对照组优3例、良8例、可3例、差1例,优良率73.3%;两组优良率比较差异无统计学意义(χ~2=0.917,P=0.821)。结论与术中切开复位相比,TSF治疗胫腓骨骨折术后采用计算机辅助闭合复位可缩短手术时间,减少术中出血量,降低长时间手术所致风险,减少骨折端血运破坏,缩短骨折愈合时间及戴架时长,减轻患者痛苦。
Objective To explore the effectiveness of Taylor spatial frame(TSF) in the treatment of tibiofibular fractures and computer-assisted closed reduction. Methods The clinical data of 30 cases of tibiofibular fractures with soft tissue injury treated with TSF between January 2015 and September 2017 was retrospectively analyzed. According to different reduction methods, the patients were divided into control group(15 cases, open reduction in TSF external fixation) and trial group(15 cases, closed reduction in 1-3 days after TSF external fixation). There was no significant difference in the general data such as gender, age, affected side, cause of injury, AO classification of fracture, time from injury to operation between the two groups(P>0.05). The operation time, intraoperative blood loss, fracture healing time,and removal time of external fixator were recorded and compared between the two groups. At 3 months after removal of external fixator, the limb function was evaluated according to Johner-Wruhs criteria for evaluating the final effect of tibial shaft fracture treatment. Results Both groups were followed up 9-16 months, with an average of 14 months. The operation time, intraoperative blood loss, fracture healing time, and removal time of external fixator in the trial group were significantly shorter than those in the control group(P<0.05). There were 2 cases of superficial infection of the external fixation(1 case in each group), 1 case of incision infection(control group), 1 case of delayed fracture healing(control group), 2 cases of traumatic arthritis(1 case in each group); no significant difference was found in the incidence of complications between the two groups(χ~2=0.370, P=0.543). The wounds of soft tissue defect healed by the first intension in both groups. At 3 months after removal of the external fixator, the limb function results in the trial group were excellent in 3 cases, good in 9 cases, fair in 2 cases, and poor in 1 case, and the excellent and good rate was 80.0%; in the control group, the results were excellent in 3 cases, good in 8 cases, fair in 3 cases, and poor in 1 case, and the excellent and good rate was 73.3%. There was no significant difference in incidence of complication between the two groups(χ~2=0.917, P=0.821). Conclusion Compared with intraoperative open reduction, postoperative computer-aided closed reduction can shorten the operation time, reduce the intraoperative blood loss, reduce the risk of long-term operation,avoid to destroy the blood supply of fracture end, shorten the healing time of fracture and the wearing time of stent, and alleviate the pain of patients after TSF treatment of tibiofibular fracture.
Objective To explore the effectiveness of Taylor spatial frame(TSF) in the treatment of tibiofibular fractures and computer-assisted closed reduction. Methods The clinical data of 30 cases of tibiofibular fractures with soft tissue injury treated with TSF between January 2015 and September 2017 was retrospectively analyzed. According to different reduction methods, the patients were divided into control group(15 cases, open reduction in TSF external fixation) and trial group(15 cases, closed reduction in 1-3 days after TSF external fixation). There was no significant difference in the general data such as gender, age, affected side, cause of injury, AO classification of fracture, time from injury to operation between the two groups(P>0.05). The operation time, intraoperative blood loss, fracture healing time,and removal time of external fixator were recorded and compared between the two groups. At 3 months after removal of external fixator, the limb function was evaluated according to Johner-Wruhs criteria for evaluating the final effect of tibial shaft fracture treatment. Results Both groups were followed up 9-16 months, with an average of 14 months. The operation time, intraoperative blood loss, fracture healing time, and removal time of external fixator in the trial group were significantly shorter than those in the control group(P<0.05). There were 2 cases of superficial infection of the external fixation(1 case in each group), 1 case of incision infection(control group), 1 case of delayed fracture healing(control group), 2 cases of traumatic arthritis(1 case in each group); no significant difference was found in the incidence of complications between the two groups(χ~2=0.370, P=0.543). The wounds of soft tissue defect healed by the first intension in both groups. At 3 months after removal of the external fixator, the limb function results in the trial group were excellent in 3 cases, good in 9 cases, fair in 2 cases, and poor in 1 case, and the excellent and good rate was 80.0%; in the control group, the results were excellent in 3 cases, good in 8 cases, fair in 3 cases, and poor in 1 case, and the excellent and good rate was 73.3%. There was no significant difference in incidence of complication between the two groups(χ~2=0.917, P=0.821). Conclusion Compared with intraoperative open reduction, postoperative computer-aided closed reduction can shorten the operation time, reduce the intraoperative blood loss, reduce the risk of long-term operation,avoid to destroy the blood supply of fracture end, shorten the healing time of fracture and the wearing time of stent, and alleviate the pain of patients after TSF treatment of tibiofibular fracture.
引文
1 Zenios M. The use of the taylor spatial frame for the treatment of unstable tibial fractures in children. J Orthop Trauma, 2013,27(10):563-568.
2 Manner HM, Huebl M, Radler C, et al. Accuracy of complex lowerlimb deformity correction with external fixation:a comparison of the Taylor Spatial Frame with the Ilizarov ring fixator. J Child Orthop, 2007,1(1):55-61.
3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.中国修复重建外科杂志,2016,30(9):1085-1088.
4秦泗河.下肢畸形与残缺外科治疗新技术新观念概论.中国矫形外科杂志,2011,19(7):599-602.
5 Johner R, Wruhs O. Classification of tibial shaft fracturesand correlation with results after rigid internal fixation. Clin Orthop Relat Res, 1983,(178):7-25.
6 Fu QG, Liu XW, Xu SG, et al. Stress-shielding effect of nitinol Swan-like memory compressive connector on fracture healing of upper limb. J Mater Eng Perform, 2009, 18(5-6):797-804.
7王德龙,刘志成.家兔骨延长术中固定刚度对骨愈合的影响.北京生物医学工程,2017, 36(5):488-494.
8夏和桃.外固定器刚度对骨折愈合的影响.中华创伤骨科杂志,2007,9(12):1170-1172.
9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.中国修复重建外科杂志,2017, 31(8):931-935.
10李公伦,王国蕊,韩锐华,等.多功能外固定支架治疗四肢严重开放性骨折病例报道.生物骨科材料与临床研究,2018, 15(4):73-74.
11 Schievano S, Taylor AM, Capelli C, et al. Patient specific finite element analysis results in more accurate prediction of stent fractures:application to percutaneous pulmonary valve implantation. J Biomech, 2009,43(4):687-693.
12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.中国修复重建外科杂志,2018, 32(2):174-177.
13张利献,席学义,张文献.骨折后局部血肿对骨痂形成的意义.中华实用医药杂志,2005, 5(8):557.
14曾宪铁,庞贵根,王宏川,等.闭合复位经皮插入锁定加压钢板技术在胫骨远端骨折的应用.中国矫形外科杂志,2008, 16(20):1584-1585.
15张英泽,韩志杰,刘欢,等.河北医科大学第三医院骨折治疗理念与原则.河北医科大学学报,2017, 38(9):1093-1095.
16刘彦士,马信龙,万春友,等.计算机辅助测量在Taylor外固定支架治疗胫腓骨骨折中的应用.中国矫形外科杂志,2017, 25(16):1457-1462.
17 Billings A, Scott DF, Camargo MP, et al. High tibial osteotomy with a calibrated osteotomy guide, rigid internal fixation, and early motion. Long-term follow-up. J Bone Joint Surg(Am), 2000, 82(1):70-79.
18 Gelalis ID, Politis AN, Arnaoutoglou CM, et al. Diagnostic and treatment modalities in nonunions of the femoral shaft:a review.Injury, 2012,43(7):980-988.
2 Manner HM, Huebl M, Radler C, et al. Accuracy of complex lowerlimb deformity correction with external fixation:a comparison of the Taylor Spatial Frame with the Ilizarov ring fixator. J Child Orthop, 2007,1(1):55-61.
3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.中国修复重建外科杂志,2016,30(9):1085-1088.
4秦泗河.下肢畸形与残缺外科治疗新技术新观念概论.中国矫形外科杂志,2011,19(7):599-602.
5 Johner R, Wruhs O. Classification of tibial shaft fracturesand correlation with results after rigid internal fixation. Clin Orthop Relat Res, 1983,(178):7-25.
6 Fu QG, Liu XW, Xu SG, et al. Stress-shielding effect of nitinol Swan-like memory compressive connector on fracture healing of upper limb. J Mater Eng Perform, 2009, 18(5-6):797-804.
7王德龙,刘志成.家兔骨延长术中固定刚度对骨愈合的影响.北京生物医学工程,2017, 36(5):488-494.
8夏和桃.外固定器刚度对骨折愈合的影响.中华创伤骨科杂志,2007,9(12):1170-1172.
9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.中国修复重建外科杂志,2017, 31(8):931-935.
10李公伦,王国蕊,韩锐华,等.多功能外固定支架治疗四肢严重开放性骨折病例报道.生物骨科材料与临床研究,2018, 15(4):73-74.
11 Schievano S, Taylor AM, Capelli C, et al. Patient specific finite element analysis results in more accurate prediction of stent fractures:application to percutaneous pulmonary valve implantation. J Biomech, 2009,43(4):687-693.
12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.中国修复重建外科杂志,2018, 32(2):174-177.
13张利献,席学义,张文献.骨折后局部血肿对骨痂形成的意义.中华实用医药杂志,2005, 5(8):557.
14曾宪铁,庞贵根,王宏川,等.闭合复位经皮插入锁定加压钢板技术在胫骨远端骨折的应用.中国矫形外科杂志,2008, 16(20):1584-1585.
15张英泽,韩志杰,刘欢,等.河北医科大学第三医院骨折治疗理念与原则.河北医科大学学报,2017, 38(9):1093-1095.
16刘彦士,马信龙,万春友,等.计算机辅助测量在Taylor外固定支架治疗胫腓骨骨折中的应用.中国矫形外科杂志,2017, 25(16):1457-1462.
17 Billings A, Scott DF, Camargo MP, et al. High tibial osteotomy with a calibrated osteotomy guide, rigid internal fixation, and early motion. Long-term follow-up. J Bone Joint Surg(Am), 2000, 82(1):70-79.
18 Gelalis ID, Politis AN, Arnaoutoglou CM, et al. Diagnostic and treatment modalities in nonunions of the femoral shaft:a review.Injury, 2012,43(7):980-988.