改良杂交架固定老年合并软组织损伤的胫腓骨干骺端骨折

Modified hybrid frame for fixation of tibiofibular metaphyseal fractures complicated with soft tissue injury in elderly

摘要:

[目的] 评价改良的杂交外固定架全程治疗老年伴有严重软组织损伤的胫腓骨干骺端骨折的疗效。[方法] 回顾性分析2020 年5 月—2023 年4 月采用改良杂交外固定架治疗，老年合并严重软组织损伤的胫腓骨干骺端骨折27 例患者的临床资料，平均（68.4±4.5） 岁。评价治疗期与随访资料。[结果] 所有患者均顺利手术，伤口愈合。骨折复位优17 例（63.0%），良10 例（37.0%），差0 例。患者住院时间（7.4±2.4） d，部分负重时间（19.7±4.5） d。随术前、术后3 d、术后1 个月的时间推移，VAS 评分显著降低[(7.1±1.4), (3.7±1.3), (1.1±1.3), P＜0.001]。所有患者随访（24.0±6.4） 个月，5 例患者（18.5%） 发生针道感染，均未引发不良后果。2 例患者骨折延迟愈合，给予戴原外固定架局部植骨。末次随访时所有患者均获得骨折愈合。随术后3、6、12 个月的时间推移，LEFS 评分[(36.7±9.7), (60.1±4.1), (75.9±2.9), P＜0.001] 显著增加。[结论] 改良杂交外固定架全程治疗老年人伴有严重软组织损伤的胫腓骨骨折，是一种安全有效的技术。

Abstract:

[Objective] To evaluate the clinical efficacy of modified hybrid external fixator for tibiofibular metaphyseal fractures com-plicated with severe soft tissue injury in the elderly. [Methods] A retrospective study was performed on 27 patients who aged of (68.4±4.5)years, and had tibiofibular metaphyseal fractures complicated with severe soft tissue injury was treated with improved hybrid external fix-ators as a full treatment from May 2020 to April 2023. The documents regarding to treatment period and follow-up were evaluated. [Re-sults] All patients received the treatment successfully and had the wound healed satisfactorily. The fracture reduction on imaging wasmarked as excellent in 17 cases (63.0%), good in 10 cases (37.0%), and poor in 0 cases. The patients had hospital stay of (7.4±2.4) days,and time to get partial weight-bearing of (19.7±4.5) days. The VAS score decreased significantly with time before surgery, 3 days after sur-gery, and 1 month postoperatively [(7.1±1.4), (3.7±1.3), (1.1±1.3), P＜0.001]. All the patients were followed up for (24.0±6.4) months, and 5patients (18.5%) of them developed pin tract infection, which didn't lead adverse consequences. In addition, 2 patients suffered from de-layed union of the fracture were given local bone grafting with the original external fixator in place. Finally, all the 27 patients got the frac-tures healed well at the last follow-up, with low extremity functional score (LEFS) significantly increased over time 3, 6 and 12 monthspostoperatively [(36.7±9.7), (60.1±4.1), (75.9±2.9), P＜0.001]. [Conclusion] The modified hybrid external fixator is a safe and effective tech-nique for the treatment of tibiofibular fractures complicated with severe soft tissue injury in the elderly.