Taylor空间支架治疗胫腓骨中下段骨折疗效观察
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摘要
目的探讨应用Taylor空间支架治疗胫腓骨中下段骨折的临床疗效和安全性。方法回顾分析2015年1月—2017年1月收治的74例胫腓骨中下段骨折患者临床资料,根据骨折固定方法不同分为内固定组(26例)和外固定组(48例)。两组患者年龄、性别、致伤原因、骨折类型、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。记录并比较两组患者术中出血量、骨折愈合时间、固定物去除时间及并发症发生情况;采用Johner-Wruhs胫骨干骨折治疗最终效果评价标准评定患肢功能;采用罗从风等的标准评定术后下肢力线恢复情况。结果两组患者均获随访,随访时间6~22个月,中位时间14个月。患者骨折均获愈合,内固定组术中出血量、骨折愈合时间及固定物去除时间均显著高于外固定组,差异有统计学意义(P<0.05)。术后内固定组发生钢板外露1例、骨折延迟愈合1例、钢板断裂1例;外固定组发生骨折延迟愈合2例、软组织缺损4例;两组并发症发生率比较差异无统计学意义(χ2=0.015,P=0.904)。术后10个月参照Johner-Wruhs标准评定患肢功能,内固定组优19例,良5例,可2例,优良率92.3%;外固定组优42例,良3例,可2例,优良率95.7%;两组优良率比较差异无统计学意义(χ2=0.392,P=0.531)。术后4个月采用罗从风等的标准评定术后下肢力线恢复情况,内固定组优24例,可1例,差1例,优良率92.3%;外固定组优46例,可1例,差1例,优良率95.8%;两组优良率比较差异无统计学意义(χ2=0.520,P=0.471)。结论采用Taylor空间支架治疗胫腓骨中下段骨折相较于采用钢板内固定治疗愈合时间短,并发症少,可减少骨折治疗周期,有利于患者骨折愈合及肢体功能恢复,相对安全可靠。
Objective To determine the effectiveness and the safety of the Taylor spatial frame in treatment of intermediate or distal tibiofibula fractures. Methods The clinical data of 74 patients with intermediate or distal tibiofibular fractures treated between January 2015 and January 2017 were retrospectively analyzed. According to fixation methods, they were divided into internal fixation group(26 cases) and external fixation group(48 cases). There was no significant difference in the age, gender, cause of injury, type of fracture, time from injury to operation between2 groups(P>0.05). The intraoperative blood loss, fracture healing time, fixator removal time, and complications were recorded and compared. The final function evaluation criteria of Johner-Wruhs humeral shaft fracture were used to evaluate the function of the affected limb. The lower limb force line recovery after operation was evaluated according to the standard evaluation of LUO Congfeng et al. Results Both groups were followed up 6-22 months(median,14 months). All patients obtained the fracture healing. The intraoperative blood loss, fracture healing time, and fixator removal time were significantly higher in the internal fixation group than those in the external fixation group(P<0.05).There were 1 case of plate exposure, 1 case of delayed fracture healing, and 1 case of plate fracture in the internal fixation group; and there were 2 cases of delayed fracture healing and 4 cases of soft tissue defect in the external fixation group; no significant difference was found in the incidence of complications between 2 groups(χ2=0.015, P=0.904). The function of the affected limb was evaluated by Johner-Wruhs standard at 10 months after operation, the results was excellent in19 cases, good in 5 cases, and fair in 2 cases in the internal fixation group, with an excellent and good rate of 92.3%; the results was excellent in 42 cases, good in 3 cases, and fair in 2 cases in the external fixation group, with an excellent and good rate of 95.7%; showing no significant difference between 2 groups(χ2=0.392, P=0.531). The lower limb force line recovery after operation was evaluated according to the standard evaluation of LUO Congfeng et al. at 4 months after operation, the results was excellent in 24 cases, fair in 1 case, poor in 1 case in the internal fixation group, with an excellent and good rate of 92.3%; the results was excellent in 46 cases, fair in 1 case, poor in 1 case in the external fixation group,with an excellent and good rate of 95.8%; showing no significant difference between 2 groups(χ2=0.520, P=0.471).Conclusion The use of Taylor spatial frame in the treatment of the intermediate or distal tibiofibular fractures can obviously reduce the healing time and complications than the internal fixation of the plate. It can reduce the fracture treatment cycle and is beneficial to the fracture healing and limb function recovery, which is relatively safe and reliable.
Objective To determine the effectiveness and the safety of the Taylor spatial frame in treatment of intermediate or distal tibiofibula fractures. Methods The clinical data of 74 patients with intermediate or distal tibiofibular fractures treated between January 2015 and January 2017 were retrospectively analyzed. According to fixation methods, they were divided into internal fixation group(26 cases) and external fixation group(48 cases). There was no significant difference in the age, gender, cause of injury, type of fracture, time from injury to operation between2 groups(P>0.05). The intraoperative blood loss, fracture healing time, fixator removal time, and complications were recorded and compared. The final function evaluation criteria of Johner-Wruhs humeral shaft fracture were used to evaluate the function of the affected limb. The lower limb force line recovery after operation was evaluated according to the standard evaluation of LUO Congfeng et al. Results Both groups were followed up 6-22 months(median,14 months). All patients obtained the fracture healing. The intraoperative blood loss, fracture healing time, and fixator removal time were significantly higher in the internal fixation group than those in the external fixation group(P<0.05).There were 1 case of plate exposure, 1 case of delayed fracture healing, and 1 case of plate fracture in the internal fixation group; and there were 2 cases of delayed fracture healing and 4 cases of soft tissue defect in the external fixation group; no significant difference was found in the incidence of complications between 2 groups(χ2=0.015, P=0.904). The function of the affected limb was evaluated by Johner-Wruhs standard at 10 months after operation, the results was excellent in19 cases, good in 5 cases, and fair in 2 cases in the internal fixation group, with an excellent and good rate of 92.3%; the results was excellent in 42 cases, good in 3 cases, and fair in 2 cases in the external fixation group, with an excellent and good rate of 95.7%; showing no significant difference between 2 groups(χ2=0.392, P=0.531). The lower limb force line recovery after operation was evaluated according to the standard evaluation of LUO Congfeng et al. at 4 months after operation, the results was excellent in 24 cases, fair in 1 case, poor in 1 case in the internal fixation group, with an excellent and good rate of 92.3%; the results was excellent in 46 cases, fair in 1 case, poor in 1 case in the external fixation group,with an excellent and good rate of 95.8%; showing no significant difference between 2 groups(χ2=0.520, P=0.471).Conclusion The use of Taylor spatial frame in the treatment of the intermediate or distal tibiofibular fractures can obviously reduce the healing time and complications than the internal fixation of the plate. It can reduce the fracture treatment cycle and is beneficial to the fracture healing and limb function recovery, which is relatively safe and reliable.
引文
1万春友,金鸿宾,张金利,等.胫腓骨复杂骨折固定研究进展.中国矫形外科杂志,2009,17(12):918-920.
2 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.
3 Sala F,Elbatrawy Y,Thabet AM,et al.Taylor spatial frame fixation in patients with multiple traumatic injuries:study of 57 long-bone fractures.J Orthop Trauma,2013,27(8):442-450.
4 Sharma H,Nunn T.Conversion of open tibialⅢb toⅢa fractures using intentional temporary deformation and the Taylor Spatial Frame.Strategies Trauma Limb Reconstr,2013,8(2):133-140.
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.中国修复重建外科杂志,2017,31(8):931-935.
6王亚洲,徐佳,康庆林.Taylor空间支架的临床应用进展.中国矫形外科杂志,2014,22(19):1773-1777.
7 Aarnes GT,Steen T,Ludvigsen P,et al.In vivo assessment of regenerate axial stiffness in distraction osteogenesis.J Orthop Res,2005,23(2):494-498.
8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.
9全先辉,万春友,刘磊,等.Taylor空间支架外固定治疗胫腓骨开放性骨折.中医正骨,2015,27(10):30-31.
10郭志民,石玲玲,田胜,等.肢体短缩延长术治疗胫骨感染性骨缺损及慢性骨髓炎疗效观察.中国修复重建外科杂志,2017,31(8):941-945.
11 Yasuda T,Arai M,Sato K,et al.A Gustilo type 3B open tibial fracture treated with a proximal flexor hallucis longus flap:a case report.J Orthop Case Rep,2017,7(2):70-73.
12 Menakaya CU,Rigby AS,Hadland Y,et al.Fracture healing following high energy tibial trauma:Ilizarov versus taylor spatial frame.Ann R Coll Surg Engl,2017,96(2):106-110.
13韩立仁,赵北,穆卫东,等.外固定架加钢板治疗伴有胫骨骨缺损的开放性胫腓骨骨折.中华创伤杂志,2013,29(3):258-261.
14 Dammerer D,Kirschbichler K,Donnan L,et al.Clinical value of the Taylor Spatial Frame:a comparison with the Ilizarov and Orthofix fixators.J Child Orthop,2011,5(5):343-349.
15 Wukich DK,Belczyk RJ.An introduction to the Taylor spatialframe for foot and ankle applications.Operative Tech Orthop,2006,16(1):2-9.
16 Henderson DJ,Rushbrook JL,Harwood PJ,et al.What are the biomechanical properties of the Taylor spatial frame~(TM)?Clin Orthop Relat Res,2017,475(5):1472-1482.
17 Rogers MJ,Mc Fadyen I,Livingstone JA,et al.Computer hexapod assisted orthopaedic surgery(CHAOS)in the correction of long bone fracture and deformity.J Orthop Trauma,2007,21(5):337-342.
18 Lahoti O,Findlay I,Shetty S,et al.Intentional deformation and closure of soft tissue defect in open tibial fractures with a Taylor spatial frame-a simple technique.J Orthop Trauma,2013,27(8):451-456.
19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.
20 Paley D,Maar DC.Ilizarov bone transport treatment for tibial defects.J Orthop Trauma,2000,14(2):76-85.
21宋文超,张思森,陈勇,等.可控性应力与微动对骨折愈合影响的CT影像结果.中华创伤骨科杂志,2015,17(7):624-627.
22喻鑫罡,张先龙,曾炳芳.低频可控性微动影响长骨骨折愈合的实验研究.中华创伤骨科杂志,2005,7(8):744-748.
2 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.
3 Sala F,Elbatrawy Y,Thabet AM,et al.Taylor spatial frame fixation in patients with multiple traumatic injuries:study of 57 long-bone fractures.J Orthop Trauma,2013,27(8):442-450.
4 Sharma H,Nunn T.Conversion of open tibialⅢb toⅢa fractures using intentional temporary deformation and the Taylor Spatial Frame.Strategies Trauma Limb Reconstr,2013,8(2):133-140.
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.中国修复重建外科杂志,2017,31(8):931-935.
6王亚洲,徐佳,康庆林.Taylor空间支架的临床应用进展.中国矫形外科杂志,2014,22(19):1773-1777.
7 Aarnes GT,Steen T,Ludvigsen P,et al.In vivo assessment of regenerate axial stiffness in distraction osteogenesis.J Orthop Res,2005,23(2):494-498.
8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.
9全先辉,万春友,刘磊,等.Taylor空间支架外固定治疗胫腓骨开放性骨折.中医正骨,2015,27(10):30-31.
10郭志民,石玲玲,田胜,等.肢体短缩延长术治疗胫骨感染性骨缺损及慢性骨髓炎疗效观察.中国修复重建外科杂志,2017,31(8):941-945.
11 Yasuda T,Arai M,Sato K,et al.A Gustilo type 3B open tibial fracture treated with a proximal flexor hallucis longus flap:a case report.J Orthop Case Rep,2017,7(2):70-73.
12 Menakaya CU,Rigby AS,Hadland Y,et al.Fracture healing following high energy tibial trauma:Ilizarov versus taylor spatial frame.Ann R Coll Surg Engl,2017,96(2):106-110.
13韩立仁,赵北,穆卫东,等.外固定架加钢板治疗伴有胫骨骨缺损的开放性胫腓骨骨折.中华创伤杂志,2013,29(3):258-261.
14 Dammerer D,Kirschbichler K,Donnan L,et al.Clinical value of the Taylor Spatial Frame:a comparison with the Ilizarov and Orthofix fixators.J Child Orthop,2011,5(5):343-349.
15 Wukich DK,Belczyk RJ.An introduction to the Taylor spatialframe for foot and ankle applications.Operative Tech Orthop,2006,16(1):2-9.
16 Henderson DJ,Rushbrook JL,Harwood PJ,et al.What are the biomechanical properties of the Taylor spatial frame~(TM)?Clin Orthop Relat Res,2017,475(5):1472-1482.
17 Rogers MJ,Mc Fadyen I,Livingstone JA,et al.Computer hexapod assisted orthopaedic surgery(CHAOS)in the correction of long bone fracture and deformity.J Orthop Trauma,2007,21(5):337-342.
18 Lahoti O,Findlay I,Shetty S,et al.Intentional deformation and closure of soft tissue defect in open tibial fractures with a Taylor spatial frame-a simple technique.J Orthop Trauma,2013,27(8):451-456.
19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.
20 Paley D,Maar DC.Ilizarov bone transport treatment for tibial defects.J Orthop Trauma,2000,14(2):76-85.
21宋文超,张思森,陈勇,等.可控性应力与微动对骨折愈合影响的CT影像结果.中华创伤骨科杂志,2015,17(7):624-627.
22喻鑫罡,张先龙,曾炳芳.低频可控性微动影响长骨骨折愈合的实验研究.中华创伤骨科杂志,2005,7(8):744-748.