胫骨开放性骨折两种外固定比较
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天津大学天津医院

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天津市自然科学基金重点项目


Comparison of two types of external fixation for open tibial fractures
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Tianjin Hospital of Tianjin University

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Tianjin Natural Science Foundation Key Projects

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    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月至2019年9月我院手术治疗的胫骨开放性骨折患者123例,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并有效随访,随访时间25~32个月,平均(26.50±1.31)个月。HEF组支架调整次数少于UEF组(P<0.05),但手术费用高于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差异无统计学意义(P>0.05)。随时间推移,两组患肢膝、踝屈伸 ROM显著改善(P<0.05)。HEF骨折临床愈合时间、带架时间早于UEF组(P<0.05)。末次随访时两组J-W评级、跛行及下蹲情况比较无统计学意义(P>0.05)。影像学评估:两组骨折复位质量逐渐改善(P<0.05),末次随访HEF组骨折复位质量优于UEF组(P<0.05)。两组患者HKA、MPTA、mLDTA角度均明显改善(P<0.05),末次随访HEF组患肢HKA、MPTA、mLDTA角度矫正优于UEF组(P<0.05)。HEF组骨折愈合时间早于UEF组(P<0.05)。[结论]应用HEF治疗胫骨开放性骨折,可较好的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 efficacy of the Hexapod External Fixator (HEF) with the Unilateral External Fixator (UEF) in the treatment of open tibial fractures. [Methods] A retrospective analysis of 123 patients with open tibial fractures surgically treated in our hospital from June 2017 to September 2019, 72 with HEF and 51 with UEF according to the results of doctor-patient communication. [Result] All patients in both groups successfully completed the surgery and were effectively followed up for 25 to 32 months, with a mean of (26.50 ± 1.31) months. The number of postoperative stent adjustments in the HEF group was less than that in the UEF group (P<0.05), but the cost of surgery was higher than that in the UEF group (P<0.05). The differences in operative time, number of intraoperative fluoroscopy, time to stand on the ground and hospital stay were not statistically significant between the two groups (P>0.05) Over time, knee and ankle flexion and extension ROM of the affected limbs improved significantly in both groups (P<0.05). The clinical healing time of the HEF fracture and the time with the frame were earlier than those of the UEF group (P<0.05). The comparison of J-W rating, claudication and squatting between the two groups at the last follow-up was not statistically significant (P>0.05). Imaging assessment: the quality of fracture reduction gradually improved in both groups over time (P<0.05), and the quality of fracture reduction was better in the HEF group than in the UEF group at the last follow-up (P<0.05). The HKA, MPTA, and mLDTA angles improved significantly in both groups (P<0.05), and the correction of HKA, MPTA, and mLDTA angles of the affected limb was better in the HEF group than in the UEF group at the last follow-up (P<0.05). Fracture healing time was earlier in the HEF group than in the UEF group at shrinkage (P<0.05). [Conclusion] The application of HEF for open tibial fractures can better improve the quality of fracture repositioning and lower limb force line angle, and shorten fracture healing and bracing time.

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  • 收稿日期:2022-05-16
  • 最后修改日期:2022-09-24
  • 录用日期:2022-12-20
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