组合外固定支架联合皮瓣移植在小腿开放性骨折患者中的应用及对肢体功能的影响研究
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摘要
目的:探讨外固定支架联合皮瓣移植对小腿开放性骨折患者肢体功能的影响。方法:选取在医院治疗的120例小腿开放性骨折患者,按随机数表法将其分为对照组和观察组,每组60例,对照组采用内固定支架固定治疗,观察组采用外固定支架联合皮瓣移植治疗。采用髋关节Harris评分量表对两组治疗后肢体功能进行评估,比较两组临床疗效及对肢体功能的影响。结果:观察组创面愈合时间、住院时间及下床时间少于对照组,差异有统计学意义(t=19.581,t=15.936,t=18.942;P<0.05);两组术前髋关节Harris评分比较差异无统计学意义(t=1.025,P>0.05);观察组术后1个月、3个月和6个月髋关节Harris评分高于对照组,差异有统计学意义(t=20.129,t=18.252,t=19.481;P<0.05);观察组术后6个月并发症发生率为6.67%,对照组为15.0%,两组并发症发生率比较差异有统计学意义(x~2=7.931,P<0.05)。结论:小腿开放性骨折患者外固定支架联合皮瓣移植治疗效果理想,能改善肢体功能。
Objective: To explore the effect of external fixation combined with skin flap transplantation on the limb function of patients with open fracture on lower leg. Methods: A total of 120 patients with open fracture on lower leg were selected from our hospital and were divided into the control group(n=60) and the observation group(n=60) as random number table. The control group received the treatment with internal fixation, and the observation group received the treatment that external fixation combined with skin flap transplantation. Harris score scale of hip joint was adopted to evaluate postoperative limb function of two groups, and the clinically curative effect and the effect of the combined method on limb function between the two groups were further compared. Results: In the observation group, the wound healing time, hospitalization time and time of getting out of bed were significantly shorter than those of control group(t=19.581, t=15.936, t=18.942, P<0.05). The difference of preoperative Harris score of hip joint between the two groups was no significant(t=1.025, P>0.05). While the Harris scores of 1 st-, 3 rd-and 6 thmonth post operation of observation group were significantly higher than those of control group(t=20.129, t=18.252, t=19.481, P<0.05).The difference of occurrence rate of complication at 6 th-month post operation between observation group(6.67%) and control group(15%) was significant(x~2=7.931, P<0.05). Conclusion: The application of external fixation combined with skin flap transplantation in the treatment for patients with open fracture of lower leg has good curative effect, and it can significantly improve prognostic limb function of patients.
Objective: To explore the effect of external fixation combined with skin flap transplantation on the limb function of patients with open fracture on lower leg. Methods: A total of 120 patients with open fracture on lower leg were selected from our hospital and were divided into the control group(n=60) and the observation group(n=60) as random number table. The control group received the treatment with internal fixation, and the observation group received the treatment that external fixation combined with skin flap transplantation. Harris score scale of hip joint was adopted to evaluate postoperative limb function of two groups, and the clinically curative effect and the effect of the combined method on limb function between the two groups were further compared. Results: In the observation group, the wound healing time, hospitalization time and time of getting out of bed were significantly shorter than those of control group(t=19.581, t=15.936, t=18.942, P<0.05). The difference of preoperative Harris score of hip joint between the two groups was no significant(t=1.025, P>0.05). While the Harris scores of 1 st-, 3 rd-and 6 thmonth post operation of observation group were significantly higher than those of control group(t=20.129, t=18.252, t=19.481, P<0.05).The difference of occurrence rate of complication at 6 th-month post operation between observation group(6.67%) and control group(15%) was significant(x~2=7.931, P<0.05). Conclusion: The application of external fixation combined with skin flap transplantation in the treatment for patients with open fracture of lower leg has good curative effect, and it can significantly improve prognostic limb function of patients.
引文
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[14]王海泉,叶正云,帅克宁,等.开放性骨折后骨外固定闭式引流治疗骨感染的临床研究[J].中华医院感染学杂志,2016,26(9):2085-2087.
[15]刘浩,丁涛,程力,等.多维与单边外固定支架治疗胫腓骨开放性骨折的临床对比研究[J].中国矫形外科杂志,2016,24(20):1854-1858.
[2]邓晓文,高秋明,樊海城,等.封闭式负压引流术在大面积软组织损伤中的应用效果[J/CD].中国医学前沿杂志:电子版,2015,7(2):81-84.
[3]康靖东,陈娟,徐伟军.外固定支架联合负压封闭引流及皮瓣移植治疗GustiloⅢA型胫腓骨骨折[J].中华损伤与修复杂志:电子版,2015,10(6):485-489.
[4]Wei D,Wang Y,Yuan J,et al.One-stage operation for pelvis and acetabular fractures combined with Morel-Lavallee injury by internal fixation associated with vacuum sealing drainage[J].Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi,2014,28(1):38-42.
[5]邓亮,何飞,吴小辉,等.骨外固定架治疗创伤后骨髓炎:联合负压封闭引流的疗效评价[J].中国组织工程研究,2014,18(44):7167-7171.
[6]Qu J,Yan R,Wang L,et al.Free dermatoplasty combined with vacuum sealing[J].Exp Ther Med,2013,5(5):1375-1380.
[7]陈绍辉,孙凯.交锁髓内钉与外固定架治疗四肢骨折患者的临床分析[J].陕西医学杂志,2014,43(4):449-450.
[8]王楠,申丰,王利祥.微型外固定支架不经关节固定开放性粉碎性指骨骨折的临床分析[J].中国骨伤,2015,28(12):1121-1124.
[9]徐佳,汪春阳,韩培,等.显微外科技术联合外固定支架在下肢严重毁损伤保肢治疗中的应用[J].中国骨与关节杂志,2015,13(12):920-923.
[10]黄小军,林庆培,罗伟初.VSD联合外固定支架用于治疗下肢开放性骨折合并软组织缺损的临床疗效[J].临床医学工程,2015,22(11):1407-1409.
[11]成亮,徐佳,柴益民,等.单边外固定支架与环形外固定支架骨搬运治疗下肢长干骨缺损的疗效及并发症比较[J].中华创伤骨科杂志,2015,17(10):863-867.
[12]Romas T,Ekholm C,Eriksson BI,et al.The Ilizarov external fixator a useful alternative for the treamient of proximal tibia fractures:a prospeetive observational study of 30 consecutive patients[J].BMC Musculoskelet Disord,2013,14(1):11-16.
[13]南宠,荆浩,周岳,等.自体微小颗粒骨植骨混合万古霉素开放性植骨修复感染性胫骨缺损[J].中国组织工程研究,2013,17(25):4585-4592.
[14]王海泉,叶正云,帅克宁,等.开放性骨折后骨外固定闭式引流治疗骨感染的临床研究[J].中华医院感染学杂志,2016,26(9):2085-2087.
[15]刘浩,丁涛,程力,等.多维与单边外固定支架治疗胫腓骨开放性骨折的临床对比研究[J].中国矫形外科杂志,2016,24(20):1854-1858.