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[1]張偉業(yè),萬春友,張濤,等.外固定器軸向載荷分擔(dān)比測試在Taylor空間支架外固定治療脛腓骨開放性骨折中的應(yīng)用[J].中醫(yī)正骨,2019,31(10):21-25.
　ZHANG Weiye,WAN Chunyou,ZHANG Tao,et al.Application of axial load sharing ratio test on external fixator to the surgery of Taylor spatial frame external fixation for treatment of open tibiofibular fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(10):21-25.
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外固定器軸向載荷分擔(dān)比測試在Taylor空間支架外固定治療脛腓骨開放性骨折中的應(yīng)用()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期數(shù):
2019年10期
頁碼:
21-25
欄目:
外固定技術(shù)
出版日期:
2019-10-20

文章信息/Info

Title:
Application of axial load sharing ratio test on external fixator to the surgery of Taylor spatial frame external fixation for treatment of open tibiofibular fractures
作者:
張偉業(yè)1; 萬春友2; 張濤2; 王明杰2; 劉釗2; 張寧寧2; 趙遠航1
(1.天津中醫(yī)藥大學(xué)研究生院,天津 301617; 2.天津市天津醫(yī)院,天津 300211)
Author(s):
ZHANG Weiye1; WAN Chunyou2; ZHANG Tao2; WANG Mingjie2; LIU Zhao2; ZHANG Ningning2; ZHAO Yuanhang1
1.Graduate college of Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China 2.Tianjin Hospital,Tianjin 300211,China
關(guān)鍵詞:
脛骨骨折;  骨折; 開放性;  骨折固定術(shù);  生物力學(xué);  Taylor空間支架;  軸向載荷
Keywords:
tibial fractures;  fractures; open;  fracture fixation;  biomechanics;  Taylor spatial frame;  axial load
摘要:
目的:探討外固定器軸向載荷分擔(dān)比測試在Taylor空間支架外固定治療脛腓骨開放性骨折中的應(yīng)用價值。方法:脛腓骨開放性骨折患者60例,按照入組順序隨機分為力學(xué)測試組和常規(guī)方法組,每組30例。2組患者均由同一組醫(yī)師行TSF外固定手術(shù)治療。力學(xué)測試組患者于術(shù)后12周X線片顯示骨折端有連續(xù)性骨痂連接時,開始行外固定器軸向載荷分擔(dān)比測試,每2周測試1次。當(dāng)外固定器軸向載荷分擔(dān)比為5%～10%時,每日在非完全負重下松開TSF的6根連接桿上的各個關(guān)節(jié),患者扶拐活動30 min給骨折斷端加壓,然后在完全負重下緊固TSF各關(guān)節(jié)。當(dāng)外固定器軸向載荷分擔(dān)比<5%時,松開TSF各關(guān)節(jié),在每日鍛煉30 min的基礎(chǔ)上適度增加鍛煉時間,鍛煉后不再緊固TSF各關(guān)節(jié),即模擬拆架。模擬拆架2周后,外固定器軸向載荷分擔(dān)比仍<5%、X線片示骨折端無移位,且患者局部無疼痛、熱、腫等表現(xiàn)時,拆除TSF。常規(guī)方法組患者術(shù)后按照常規(guī)方法,根據(jù)骨折愈合時間、影像學(xué)檢查結(jié)果以及臨床醫(yī)師經(jīng)驗評價骨折愈合程度,骨折達到臨床愈合標(biāo)準(zhǔn)時拆除TSF。記錄2組患者的TSF固定時間、骨折愈合時間,隨訪觀察并發(fā)癥發(fā)生情況。結(jié)果:2組患者均獲隨訪,隨訪時間4～13個月,中位數(shù)8個月。力學(xué)測試組患肢軸向載荷分擔(dān)比降至5%～10%的時間為(19.57±1.95)周、降至5%以下的時間為(23.07±2.26)周,TSF固定時間短于常規(guī)方法組[(24.67±1.42)周,(33.47±2.63)周; t=15.851,P=0.000]。2組患者骨折均愈合,力學(xué)測試組骨折愈合時間短于常規(guī)方法組[(20.90±2.48)周,(31.2±2.79)周; t=14.869,P=0.000]。力學(xué)測試組術(shù)后發(fā)生針道感染2例、骨折延遲愈合2例(愈合時間分別為30周、32周),常規(guī)方法組術(shù)后并發(fā)針道感染3例、骨折延遲愈合4例(愈合時間分別為37周、37周、40周、41周),針道感染者均經(jīng)換藥等處理后針道愈合; 均未發(fā)生外固定架松動、斷裂及骨折移位、再骨折等并發(fā)癥; 2組患者并發(fā)癥發(fā)生率比較,差異無統(tǒng)計學(xué)意義(χ2=1.002,P=0.317)。結(jié)論:采用TSF外固定治療脛腓骨開放性骨折,術(shù)后根據(jù)外固定器軸向載荷分擔(dān)比的測試結(jié)果逐步拆除外固定架,可縮短TSF固定時間和骨折愈合時間,安全可靠。
Abstract:
Objective:To explore the applied values of axial load sharing ratio test on external fixator in the surgery of Taylor spatial frame(TSF)external fixation for treatment of open tibiofibular fractures.Methods:Sixty patients with open tibiofibular fractures were selected and randomly divided into mechanical test group and conventional method group according to their enrolled sequence,30 cases in each group.The surgeries of TSF external fixation were performed on patients in the 2 groups by the same group of surgeons.The axial load sharing ratio tests were performed on patients in mechanical test group when continuous bony callus were found at the broken ends on X-ray films at 12 weeks after the surgery.The tests were performed every other week.The joints on the 6 connecting rods of TSF were loosened every day under the premise of partial weight-bearing when the axial load sharing ratio reached 5%-10%,and the patients were asked to walk with crutches for 30 minutes for compressing the broken ends,and then all joints of TSF were tightened under the premise of full weight-bearing.The joints on the 6 connecting rods of TSF were loosened when the axial load sharing ratio was<5%,and the everyday exercise time was moderately increased.After the exercises,the joints of TSF were no longer tightened,in other words,the simulated removal of TSF was performed.After 2-week simulation,the TSF was removed when the axial load sharing ratio was<5% and no displacement of broken ends on X-ray films and regional pain,heat and swelling were found.The TSFs were removed from patients in conventional method group when the fracture healing reached the clinical healing standards according to fracture healing time,imaging examination results and experience of clinicians.The TSF fixation time and fracture healing time were recorded and compared between the 2 groups.The patients were followed up and the complication incidences were observed and compared between the 2 groups.Results:All patients in the 2 groups were followed up for 4-13 months with a median of 8 months.The axial load sharing ratio of TSF decreased to 5%-10% in 19.57+/-1.95 weeks and decreased to<5% in 23.07+/-2.26 weeks respectively in mechanical test group.The TSF fixation time was shorter in mechanical test group compared to conventional method group(24.67+/-1.42 vs 33.47+/-2.63 weeks,t=15.851,P=0.000).All fractures healed in the 2 groups,and the fracture healing time was shorter in mechanical test group compared to conventional method group(20.90+/-2.48 vs 31.2+/-2.79 weeks,t=14.869,P=0.000).The postoperative pin hole infection was found in 2 patients in mechanical test group and 3 patients in conventional method group,and the delayed union of fracture was found in 2 patients(the fracture healing time was 30 and 32 weeks repectively)in mechanical test group and 4 patients(the fracture healing time was 37,37,40 and 41 weeks repectively)in conventional method group.The pin hole healed after dressing change.No complications such as loosening or breakage of external fixators,fracture displacement and refracture were found in the 2 groups.There was no statistical difference in complication incidences between the 2 groups(χ2=1.002,P=0.317).Conclusion:Gradual TSF removal under the guidance of axial load sharing ratio test on TSF can shorten TSF fixation time and fracture healing time in treatment of open tibiofibular fractures,and it is safe and reliable.

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通訊作者:萬春友 E-mail:[email protected](收稿日期:2019-08-01 本文編輯:楊雅)
更新日期/Last Update: 2019-10-15