胫骨开放性骨折两种外固定比较△

Comparison of two external fixators for open tibial shaft fractures

摘要:

［目的］ 比较六轴空间外固定支架 （hexapod external fixator, HEF） 与单臂外固定支架 （unilateral external fixator, UEF）治疗胫骨开放性骨折的临床疗效。［方法］回顾性分析 2017 年 6 月—2019 年 9 月本院手术治疗的胫骨开放性骨折 12 例患者的临床资料，根据医患沟通结果，72 例采用 HEF，51 例采用 UEF。比较两组患者围手术期、随访和影像资料。［结果］两组患者均顺利完成手术，HEF 组术后支架调整次数显著少于 UEF 组 （P<0.05），HEF 组术后负重活动时间显著早于 UEFA 组 （P<0.05），但 HEF 组手术费用显著高于 UEF 组（P<0.05）。两组手术时间、术中透视次数、下地站立时间及住院时间的差异均无统计学意义（P>0.05）。随访时间平均（26.5±1.3）个月。HEF 组拆除外固定支架时间显著早于 UEF 组（P<0.05）。随时间推移，两组患肢膝、踝屈伸 ROM 显著改善（P<0.05），相应时间点两组间差异无统计学意义（P>0.05）。末次随访时两组 JohnerWruhs 评级、跛行及下蹲情况比较差异无统计学意义 （P>0.05）。影像方面，随术后时间推移，两组骨折对位对线和胫骨短缩均显著改善（P<0.05），HEF 组骨折愈合时间显著早于 UEF 组（P<0.05）。末次随访 HEF 组骨折对位对线和胫骨短缩均显著优于 UEF 组（P<0.05）。［结论］应用 HEF 治疗胫骨开放性骨折，可较好地改善骨折复位质量和下肢力线角度，缩短骨折愈合和带架时间。

Abstract:

[Objective] To compare the clinical outcomes of hexapod external fixator (HEF) versus unilateral external fixator (UEF) for open tibial shaft fractures. [Methods] A retrospective study was performed on 123 patients who had open tibial shaft fractures treated in our hospital from June 2017 to September 2019. According to the results of doctor-patient communication, 72 patients received HEF, while the remaining 51 patients were used UEF. The perioperative period, follow-up and imaging data were compared between the two groups. [Results] All the patients in both groups had operation finished successfully. The HEF group proved significantly superior to the UEF in terms of the number of postoperative frame adjustment and time to resume postoperative weight-bearing activity (P＜0.05), but the former costed significantly more than the latter (P＜0.05). There were no significant differences in operation time, intraoperative fluoroscopy times, time to stand on ground and hospital stay between the two groups (P＞0.05). All the patients were followed up for (26.5±1.3) months on an average, and the HEF group had the external fixator removed significantly earlier than the UEF group (P＜0.05). The knee and ankle flexion- exten- sion ROM significantly improved over time in both groups (P＜0.05), whereas which were not significant different between the two groups at any corresponding time points (P＞0.05). In addition, there was no significant difference in Johner-Wruhs grade, as well as claudication and squatting scales between the two groups at the latest follow-up (P＜0.05). Radiographically, fracture alignment and tibial shortening were significantly improved in both groups with postoperative time (P＜0.05). The HEF group proved significantly superior to the UEF in terms of fracture healing time on images, as well as the fracture alignment and tibial shortening at the latest follow-up (P＜0.05). [Conclusion] The HEF for open tibial shaft fractures does improve the quality of fracture reduction, and shorten the time of frame bearing and fracture healing compared with the traditional UEF.