外固定架终极治疗成年人胫骨干闭合性骨折的临床研究

目的 探讨外固定架终极治疗成年人胫骨干闭合性骨折的临床疗效。方法 2012年6月—2017年6月应用外固定架终极治疗成年人胫骨干闭合性骨折患者47例,术前根据骨折类型设计外固定架构型,术中X线透视机确认闭合复位骨折满意后安装外固定架,术后加强钉道护理预防感染,定期随访,根据X线片所示骨愈合矿化情况逐步拆除固定组件。结果 47例患者随访12～36个月,平均为(19.96±1.42)个月。其中45例患者骨折愈合良好,2例发生骨不连,骨愈合率为95.74%,骨折愈合所需时间4～14月,平均为(5.63±0.78)个月。其中1例患者发生骨不连采取二次手术更换钢板并取自体髂骨植骨后愈合,另1例患者发生萎缩性骨不连通过使用环形外固定架骨搬运技术治愈。3例患者发生轻度的钉道感染,经清创换药外用抗菌药物治愈。所有骨折患者均未采用跨关节固定构型,膝踝关节活动功能无明显影响。结论 外固定架终极治疗成年人胫骨干闭合性骨折临床疗效满意,合适的外固定构型可为骨折愈合提供稳定可靠的固定强度,并且可以根据骨愈合情况调整固定强度改善应力遮挡,避免二次手术治疗,具有一定的临床应用价值。

Clinical research on the ultimate treatment of adult tibial shaft closed fracture with external fixator

Objective To investigate the clinical effect of external fixator in the treatment of adult tibial shaft closed fracture. Methods Forty-seven adult patients with tibial shaft closed fracture were treated with external fixator. An external fixation framework was designed according to the type of fracture before surgery, and an external fixation frame was installed after the intraoperative X-ray fluoroscopy machine confirmed the closed reduction fracture was satisfactory. Nursing of nail track was strengthened after operation to prevent infection and all patients were followed up at regular intervals. According to the condition of bone healing mineralization shown in X-ray films, components of the frame were gradually dismantled to total remove of the frame in regular intervals. Results Forty-seven patients were followed up 12 to 36 months, with an average of (19.96±1.42) months. Forty-five cases of 47 patients healed normally and 2 patients had nonunion, with the healing rate 95.74%. The fracture healing time was from 4 to 14 months, with an average of (5.63±0.78) months. One case of nonunion healed smoothly after replacing plate and bone grafting, and the other one healed smoothly after Bone transport technique with ring external fixator. Three patients with mild pin-tract infection were cured after debridement and changing dressing associated with antibiotics. There were no impacts on the knee and ankle function in all patients. Conclusion External fixator is the ultimate treatment for closed fracture of tibial shaft in adults with satisfactory clinical efficacy. The appropriate external fixator can provide stable and reliable fixation strength for fracture healing, and can adjust the fixation strength according to the bone healing situation to improve stress shielding and avoid secondary surgical treatment, which has certain clinical application value.