摘要
目的:探讨外固定器轴向载荷分担比测试在Taylor空间支架外固定治疗胫腓骨开放性骨折中的应用价值。方法:胫腓骨开放性骨折患者60例,按照入组顺序随机分为力学测试组和常规方法组,每组30例。2组患者均由同一组医师行TSF外固定手术治疗。力学测试组患者于术后12周X线片显示骨折端有连续性骨痂连接时,开始行外固定器轴向载荷分担比测试,每2周测试1次。当外固定器轴向载荷分担比为5%~10%时,每日在非完全负重下松开TSF的6根连接杆上的各个关节,患者扶拐活动30min给骨折断端加压,然后在完全负重下紧固TSF各关节。当外固定器轴向载荷分担比<5%时,松开TSF各关节,在每日锻炼30min的基础上适度增加锻炼时间,锻炼后不再紧固TSF各关节,即模拟拆架。模拟拆架2周后,外固定器轴向载荷分担比仍<5%、X线片示骨折端无移位,且患者局部无疼痛、热、肿等表现时,拆除TSF。常规方法组患者术后按照常规方法,根据骨折愈合时间、影像学检查结果以及临床医师经验评价骨折愈合程度,骨折达到临床愈合标准时拆除TSF。记录2组患者的TSF固定时间、骨折愈合时间,随访观察并发症发生情况。结果:2组患者均获随访,随访时间4~13个月,中位数8个月。力学测试组患肢轴向载荷分担比降至5%~10%的时间为(19.57±1.95)周、降至5%以下的时间为(23.07±2.26)周,TSF固定时间短于常规方法组[(24.67±1.42)周,(33.47±2.63)周;t=15.851,P=0.000]。2组患者骨折均愈合,力学测试组骨折愈合时间短于常规方法组[(20.90±2.48)周,(31.2±2.79)周;t=14.869,P=0.000]。力学测试组术后发生针道感染2例、骨折延迟愈合2例(愈合时间分别为30周、32周),常规方法组术后并发针道感染3例、骨折延迟愈合4例(愈合时间分别为37周、37周、40周、41周),针道感染者均经换药等处理后针道愈合;均未发生外固定架松动、断裂及骨折移位、再骨
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
作者
张伟业
万春友
张涛
王明杰
刘钊
张宁宁
赵远航
ZHANG Weiye;WAN Chunyou;ZHANG Tao;WANG Mingjie;LIU Zhao;ZHANG Ningning;ZHAO Yuanhang(Graduate college of Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China;Tianjin Hospital,Tianjin 300211,China)
出处
《中医正骨》
2019年第10期21-25,共5页
The Journal of Traditional Chinese Orthopedics and Traumatology
