胫腓双骨折内固定是否固定腓骨的比较
Surgical fixation of tibiofibular double fractures with or without fixation of fibular fractures
陈尚桐 1陈跃平 2黄川洪 1董盼锋 2章晓云 2卓映宏 2黄柯琪 1李加根1
作者信息
- 1. 广西中医药大学,广西南宁 530001
- 2. 广西中医药大学附属瑞康医院创伤骨科,广西南宁 530001
- 折叠
摘要
[目的]比较胫腓双骨折开放复位内固定术是否固定腓骨的临床疗效.[方法]回顾性分析2018年1月—2020年1月广西中医药大学附属瑞康医院创伤骨科收治的54例胫腓骨双骨折患者的临床资料,依据术前医患沟通结果,29例固定腓骨,25例不固定腓骨.比较两组围手术期、随访和影像资料.[结果]所有患者均顺利完成手术,术中无相关并发症发生.固定组手术时间[(112.4±13.3)min vs(81.0±11.2)min,P＜0.001]、切口总长度[(7.0±1.3)cm vs(4.9±1.2)cm,P＜0.001]显著长于未固定组,但前者术中透视次数[(3.0±0.9)次vs(5.1±1.4)次,P＜0.001]、术后首次触地时间[(8.4±1.4)d vs(24.9±3.0)d,P＜0.001]均显著少于后者.所有患者获得随访,随访时间12～18个月.固定组恢复完全负重活动时间显著早于未固定组[(22.1±1.3)周vs(23.4±1.0)周,P＜0.001].与术后3个月相比,末次随访时,两组VAS、HSS、AOFAS评分及踝背伸-跖屈ROM均显著改善(P＜0.05).末次随访时,固定组 VAS[(0.2±0.3)vs(1.3±0.8),P＜0.001]、HSS[(88.8±0.7)vs(87.3±2.1),P＜0.001]、AOFAS[(91.3±6.6)vs(79.7±14.0),P＜0.001]评分及膝伸-屈 ROM[(134.9±5.5)° vs(126.2±6.1)°,P＜0.001]、踝背伸-跖屈 ROM[(58.1±8.4)° vs(44.2±10.4)°,P＜0.001]均优于非固定组.影像方面,固定组的骨折复位优良率显著高于未固定组(P＜0.05),固定组的影像骨折愈合时间显著早于非固定组(P＜0.05).[结论]对胫腓骨双骨折开放复位内固定中,固定腓骨临床结果更优,是一种可行的方法.
Abstract
[Objective]To compare the clinical efficacy of open reduction and internal fixation for tibiofibular fractures with or without fixation of the fibular fracture.[Methods]A retrospective analysis was conducted on 54 patients who received surgical treatment for tibiofib-ular fractures in the Department of Traumatic Orthopedic,Ruikang Hospital,Guangxi University of Traditional Chinese Medicine from Janu-ary 2018 to January 2020.Based on preoperative communication between doctors and patients,29 patients had tibial fracture fixed,com-bined with fibular fracture fixed simultaneously(the fixed group),while other 25 patients had the tibial fracture fixed only,without fixation of the fibular fracture(the non-fixed group).The perioperative,follow-up,and imaging data were compared between two groups.[Results]All the patients in both cohorts had the surgical procedures successfully completed without any related complications during the operation.Al-though the fixed group had significantly longer surgical time[(112.4±13.3)min vs(81.0±11.2)min,P＜0.001]and total incision length[(7.0±1.3)cm vs(4.9±1.2)cm,P＜0.001]than the non-fixed group,the former had significantly fewer intraoperative fluoroscopy times[(3.0±0.9)times vs(5.1±1.4)times,P＜0.001]and resumed postoperative walking significantly earlier than the latter[(8.4±1.4)days vs(24.9±3.0)days,P＜0.001].All patients in both cohorts were followed up for a period of 12～18 months,and the fixed cohort resumed full weight-bearing activ-ity significantly earlier than the unfixed group[(22.1±1.3)weeks vs(23.4±1.0)weeks,P＜0.001].Compared with those 3 months after surgery,both groups showed significant improvements in VAS,HSS,AOFAS scores,and ankle dorsal flexion-plantar flexion range of motion(ROM)(P＜0.05)at the last follow-up.The fixed cohort proved significantly superior to the non-fixed counterpart in terms of VAS[(0.2±0.3)vs(1.3±0.8),P＜0.001],HSS[(88.8±0.7)vs(87.3±2.1),P＜0.001],AOFAS[(91.3±6.6)vs(79.7±14.0),P＜0.001],knee extension-flexion ROM[(134.9±5.5)° vs(126.2±6.1)°,P＜0.001],and ankle ROM[(58.1±8.4)° vs(44.2±10.4)°,P＜0.001]at the latest interview.Regarding imaging,the fixed group also was significantly better than the non-fixed group in excellent rate of fracture reduction and the imaging fracture healing time(P＜0.05).[Conclusion]In openreduction and internal fixation of tibiofibular double fractures,fixing the fibular fracture yields better clinical outcomes,and is a feasible method.
关键词
胫骨腓骨骨折/骨折固定术/腓骨固定/腓骨不固定Key words
tibiofibular fractures/surgical fracture fixation/fibular fixation/non fibular fixation引用本文复制引用
基金项目
广西临床重点专科(创伤外科)建设项目(桂卫医发202117号)
广西壮族自治区医疗卫生临床重点学科急诊医学科建设项目(桂卫科教发20218号文件)
广西中医药大学桂派中医药传承创新团队项目(A类)(2022A004)
出版年
2024
NETL
NSTL
万方数据