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[1]李國(guó)梁,王旭洋,趙建勇,等.腓骨穿針內(nèi)固定聯(lián)合孟氏架外固定治療脛腓骨骨折的臨床研究[J].中醫(yī)正骨,2021,33(04):22-27.
　LI Guoliang,WANG Xuyang,ZHAO Jianyong,et al.A clinical study of fibular Kirschner wire internal fixation combined with Meng’s fixator external fixation for treatment of tibiofibular fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(04):22-27.
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腓骨穿針內(nèi)固定聯(lián)合孟氏架外固定治療脛腓骨骨折的臨床研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期數(shù):
2021年04期
頁碼:
22-27
欄目:
臨床研究
出版日期:
2021-04-20

文章信息/Info

Title:
A clinical study of fibular Kirschner wire internal fixation combined with Meng’s fixator external fixation for treatment of tibiofibular fractures
作者:
李國(guó)梁; 王旭洋; 趙建勇; 張亮; 于君君; 韓廣普
(河北省滄州中西醫(yī)結(jié)合醫(yī)院,河北 滄州 061001)
Author(s):
LI Guoliang; WANG Xuyang; ZHAO Jianyong; ZHANG Liang; YU Junjun; HAN Guangpu
Cangzhou Hospital of Integrated TCM-WM·Hebei,Cangzhou 061001,Hebei,China
關(guān)鍵詞:
脛骨骨折;  腓骨;  骨折固定術(shù); 內(nèi);  外固定器;  臨床試驗(yàn)
Keywords:
tibial fractures;  fibula;  fracture fixation; internal;  external fixators;  clinical trial
摘要:
目的:探討腓骨穿針內(nèi)固定聯(lián)合孟氏架外固定治療脛腓骨骨折的臨床療效和安全性。方法:將102例脛腓骨骨折患者隨機(jī)分為2組,每組51例,分別采用單純孟氏架外固定和腓骨穿針內(nèi)固定聯(lián)合孟氏架外固定治療。記錄并比較2組患者的手術(shù)時(shí)間、術(shù)中出血量、術(shù)后下床時(shí)間、住院時(shí)間、骨折愈合時(shí)間、Fugl-meyer下肢運(yùn)動(dòng)功能評(píng)分、美國(guó)足與踝關(guān)節(jié)協(xié)會(huì)(American Orthopaedic Foot and Ankle Society,AOFAS)踝與后足功能評(píng)分、綜合療效和并發(fā)癥發(fā)生情況。結(jié)果:①一般指標(biāo)。聯(lián)合固定組患者的手術(shù)時(shí)間長(zhǎng)于孟氏架外固定組[(129.38±19.23)min,(108.35±15.57)min,t=6.070,P=0.000]、術(shù)中出血量多于孟氏架外固定組[(198.68±25.13)mL,(169.12±24.09)mL,t=6.064,P=0.000],術(shù)后下地時(shí)間、住院時(shí)間、骨折愈合時(shí)間均短于孟氏架外固定組[(15.91±5.98)d,(19.81±5.57)d,t=3.408,P=0.001;(20.67±6.17)d,(24.71±6.98)d,t=3.097,P=0.003;(61.81±5.57)d,(69.12±5.76)d,t=6.515,P=0.001]。②Fugl-meyer下肢運(yùn)動(dòng)功能評(píng)分。術(shù)前2組患者Fugl-meyer下肢運(yùn)動(dòng)功能評(píng)分比較,差異無統(tǒng)計(jì)學(xué)意義[(9.98±3.75)分,(9.19±3.54)分,t=13.392,P=0.410]; 術(shù)后6個(gè)月,聯(lián)合固定組患者的Fugl-meyer下肢運(yùn)動(dòng)功能評(píng)分高于孟氏架外固定組[(27.36±4.96)分,(24.12±4.76)分,t=9.013,P=0.011],2組患者Fugl-meyer下肢運(yùn)動(dòng)功能評(píng)分均高于術(shù)前(t=19.961,P=0.000; t=17.973,P=0.000)。③AOFAS踝與后足功能評(píng)分。術(shù)前2組患者AOFAS踝與后足功能評(píng)分比較,差異無統(tǒng)計(jì)學(xué)意義[(51.28±5.59)分,(50.64±5.26)分,t=10.437,P=0.641]; 術(shù)后6個(gè)月,聯(lián)合固定組患者的AOFAS踝與后足功能評(píng)分高于孟氏架外固定組[(84.82±7.92)分,(80.05±7.76)分,t=7.481,P=0.027],2組患者AOFAS踝與后足功能評(píng)分均高于術(shù)前(t=24.708,P=0.000; t=22.404,P=0.000)。④綜合療效。術(shù)后6個(gè)月,2組患者的綜合療效比較,差異無統(tǒng)計(jì)學(xué)意義(Z=-1.820,P=0.069)。⑤并發(fā)癥。孟氏架外固定組術(shù)后出現(xiàn)切口感染3例、下肢深靜脈血栓2例、固定針?biāo)蓜?dòng)2例、神經(jīng)損傷1例,聯(lián)合固定組術(shù)后出現(xiàn)切口感染2例、下肢深靜脈血栓1例、固定針?biāo)蓜?dòng)1例、神經(jīng)損傷1例; 2組患者并發(fā)癥發(fā)生率比較,差異無統(tǒng)計(jì)學(xué)意義(χ2=0.793,P=0.373)。結(jié)論:腓骨穿針內(nèi)固定聯(lián)合孟氏架外固定治療脛腓骨骨折,較單純孟氏架外固定能更好地促進(jìn)下肢運(yùn)動(dòng)功能和踝關(guān)節(jié)功能的恢復(fù),且住院時(shí)間短、骨折愈合快、術(shù)后下床時(shí)間早,但手術(shù)時(shí)間長(zhǎng)、術(shù)中出血量多,且二者的綜合療效和安全性相當(dāng)。
Abstract:
To explore the clinical curative effects and safety of fibular Kirschner wire(K-wire)internal fixation combined with Meng’s fixator external fixation for treatment of tibiofibular fractures.Methods:One hundred and two patients with tibiofibular fractures were randomly divided into 2 groups,51 cases in each group,and were treated with monotherapy of Meng’s fixator external fixation(monotherapy group)and combination therapy of fibular K-wire internal fixation and Meng’s fixator external fixation(combination therapy group)respectively.The operative time,intraoperative blood loss,bed rest time,hospital stays,fracture healing time,Fugl-meyer(FM)lower extremity motor subscores,American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot function scores,total clinical curative effects and complication incidence were recorded and compared between the 2 groups respectively.Results:The operative time was longer,the intraoperative blood loss was more and the bed rest time,hospital stays and fracture healing time were shorter in combination therapy group compared to monotherapy group(129.38±19.23 vs 108.35±15.57 minutes,t=6.070,P=0.000; 198.68±25.13 vs 169.12±24.09 mL,t=6.064,P=0.000; 15.91±5.98 vs 19.81±5.57 days,t=3.408,P=0.001; 20.67±6.17 vs 24.71±6.98 days,t=3.097,P=0.003; 61.81±5.57 vs 69.12±5.76 days,t=6.515,P=0.001).There was no statistical difference in FM lower extremity motor subscores between the 2 groups before the surgery(9.98±3.75 vs 9.19±3.54 points,t=13.392,P=0.410).The FM lower extremity motor subscores were higher in combination therapy group compared to monotherapy group at 6 months after the surgery(27.36±4.96 vs 24.12±4.76 points,t=9.013,P=0.011),and were higher at 6 months after the surgery compared to pre-surgery in the 2 groups(t=19.961,P=0.000; t=17.973,P=0.000).There was no statistical difference in AOFAS ankle-hindfoot function scores between the 2 groups before the surgery(51.28±5.59 vs 50.64±5.26 points,t=10.437,P=0.641).The AOFAS ankle-hindfoot function scores were higher in combination therapy group compared to monotherapy group at 6 months after the surgery(84.82±7.92 vs 80.05±7.76 points,t=7.481,P=0.027),and were higher at 6 months after the surgery compared to pre-surgery in the 2 groups(t=24.708,P=0.000; t=22.404,P=0.000).There was no statistical difference in total clinical curative effects between the 2 groups at 6 months after the surgery(Z=-1.820,P=0.069).After the surgery,incision infection(3),lower extremity deep venous thrombosis(2),K-wire loosening(2)and nerve injury(1)were found in monotherapy group; while incision infection(2),lower extremity deep venous thrombosis(1),K-wire loosening(1)and nerve injury(1)were found in combination therapy group.There was no statistical difference in complication incidences between the 2 groups(χ2=0.793,P=0.373).Conclusion:The combination therapy of fibular K-wire internal fixation and Meng’s fixator external fixation can better promote the recovery of lower extremity motor function and ankle function compared to monotherapy of Meng’s fixator external fixation in treatment of tibiofibular fractures,and it has such advantages as shorter hospital stays and bed rest time and faster fracture healing,but disadvantages as longer operative time and more intraoperative blood loss,while the two therapies are similar to each other in total clinical curative effects and safety.

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