开放性胫腓骨骨折合并胫骨骨缺损的手术治疗效果分析
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摘要
目的探讨开放性胫腓骨骨折合并胫骨骨缺损的手术治疗措施。方法方便选取2016年1月—2017年12月该院收治的50方式不同分为A组(22例)和B组(28例),A组患者采用Ilizarov骨搬移术,B组例胫腓骨骨折合并胫骨骨缺损患者,根据治疗患者采用Ilizarov骨缩短-延长术,并比较不同组患者治疗效果和并发症发生率。结果 B组患者膝关节功能治疗有效率(85.71%vs. 81.82%)高于A组,但两者比较差异无统计学意义(χ~2=0.139,P=0.709);两组患者皮瓣移植均成活,B组患者骨缺损端自然愈合率(67.86%vs 68.18%)、二次清理后愈合率(17.86%vs 27.27%)以及复植后愈合率(14.29%vs 4.55%)与A组比较差异无统计学意义(χ~2=0.001、0.636、1.299,P=0.981、0.425、0.254);B组患者骨缺损端愈合时间[(0.88±0.19)年vs(1.21±0.16)年]明显少于A组(t=0.626,P=0.000);B组患者术后并发症发生率(50.00%vs 54.55%)低于A组,但两者比较差异无统计学意义(χ~2=1.672,P=0.196)。结论Ilizarov骨搬移术与Ilizarov骨缩短-延长术均是治疗开放性胫腓骨骨折合并胫骨骨缺损的有效方法 ,但后者骨缺损端愈合时间更短。
Objective To explore the surgical treatment of open tibiofibular fracture combined with tibial bone defect.Methods A total of 50 patients with tibiofibular fractures and tibia bone defects admitted to our hospital from January 2016 to December 2017 were convenient divided into group A(22 cases) and group B(28 cases) according to different treatment methods. Group A patients used Ilizarov bone transfer, group B patients with Ilizarov bone shortening-prolongation, and compared the treatment effect and complication rate of different groups of patients. Results The effective rate of knee joint function in group B(85.71% vs 81.82%) was higher than that in group A, but the difference was not statistically significant(χ~2=0.139, P=0.709). The flaps survived in both groups. The natural healing rate of bone defect end in group B(67.86% vs.68.18%), the healing rate after secondary cleansing(17.86% vs 27.27%) and the healing rate after replantation(14.29% vs.4.55%) were not statistically different from group A(χ~2=0.001, 0.636, 1.299, P=0.981, 0.425, 0.254). The bone defect healing time of group B [(0.88±0.19) years vs(1.21±0.16) years] was significantly shorter than that of group A(t=0.626, P=0.000).The incidence of postoperative complications in group B(50.00% vs 54.55%) was lower than that in group A, but the difference was not statistically significant(χ~2=1.672, P=0.196). Conclusion Ilizarov bone transfer and Ilizarov bone shorteningprolongation are effective methods for the treatment of open tibial fracture with tibial bone defect, but the latter has a shorter healing time.
Objective To explore the surgical treatment of open tibiofibular fracture combined with tibial bone defect.Methods A total of 50 patients with tibiofibular fractures and tibia bone defects admitted to our hospital from January 2016 to December 2017 were convenient divided into group A(22 cases) and group B(28 cases) according to different treatment methods. Group A patients used Ilizarov bone transfer, group B patients with Ilizarov bone shortening-prolongation, and compared the treatment effect and complication rate of different groups of patients. Results The effective rate of knee joint function in group B(85.71% vs 81.82%) was higher than that in group A, but the difference was not statistically significant(χ~2=0.139, P=0.709). The flaps survived in both groups. The natural healing rate of bone defect end in group B(67.86% vs.68.18%), the healing rate after secondary cleansing(17.86% vs 27.27%) and the healing rate after replantation(14.29% vs.4.55%) were not statistically different from group A(χ~2=0.001, 0.636, 1.299, P=0.981, 0.425, 0.254). The bone defect healing time of group B [(0.88±0.19) years vs(1.21±0.16) years] was significantly shorter than that of group A(t=0.626, P=0.000).The incidence of postoperative complications in group B(50.00% vs 54.55%) was lower than that in group A, but the difference was not statistically significant(χ~2=1.672, P=0.196). Conclusion Ilizarov bone transfer and Ilizarov bone shorteningprolongation are effective methods for the treatment of open tibial fracture with tibial bone defect, but the latter has a shorter healing time.
引文
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[10]宰庆书,刘冬彩. Ilizarov技术行骨搬运与骨短缩-延长治疗胫骨骨缺损合并软组织缺损的疗效对比[J].南昌大学学报:医学版,2018,58(3):31-35.
[2]黄海德,宋宜鹃.胫腓骨开放性骨折的急诊处置及固定方式对创面感染的影响研究[J].中国医药科学,2018,8(17):254-257.
[3]韦星.单侧多功能外固定架治疗开放性胫腓骨骨折的临床分析[J].医学理论与实践,2018, 31(10):1467-1469.
[4]张飞,彭吾训,张健,等.单边多功能外固定架骨搬运治疗胫骨创伤后骨髓炎合并骨缺损的疗效分析[J].中国现代医学杂志,2018,28(20):117-120.
[5]韩立仁,赵北,贺新兵,等.开放性胫腓骨骨折合并胫骨骨缺损的手术治疗[J].中国骨与关节损伤杂志,2014,29(4):356-358.
[6]王郑钢,张卫,肖湘君,等.骨搬运术治疗胫骨骨折合并骨缺损的临床效果及作用机制[J].山东医药,2018,58(32):61-63.
[7]王兴国,王伟,王兴义,等.应用Ilizarov技术一期治疗合并皮肤缺损的胫骨感染性骨缺损[J].中国骨伤,2010,23(6):422-425.
[8]张辉,许亚军,陈政,等.线捆绑游离皮质骨块包裹松质骨植骨治疗胫骨节段性骨缺损疗效[J].中国现代医学杂志,2017,27(8):109-113.
[9]崔军,李旭,莫忆南. Ilizarov骨搬移技术治疗创伤性胫骨骨缺损合并软组织缺损的临床研究[J].中国临床医生杂志,2018,46(9):1075-1078.
[10]宰庆书,刘冬彩. Ilizarov技术行骨搬运与骨短缩-延长治疗胫骨骨缺损合并软组织缺损的疗效对比[J].南昌大学学报:医学版,2018,58(3):31-35.