胫腓骨开放性骨折外固定支架分期治疗和终末治疗对患者预后的影响

目的探讨外固定支架行分期治疗和终末治疗对胫腓骨开放性骨折患者健康相关生命质量及功能的影响。方法回顾性研究2017年3月至2018年10月西安交通大学医学院附属红会医院创伤骨科下肢病区收治的52例胫腓骨开放性骨折患者资料。男37例,女14例;年龄19~62岁,平均39.9岁。根据治疗方案分为分期治疗组(A组,拆除外固定支架后更换为内固定,35例)和终末治疗组(B组,以外固定支架作为终末治疗,17例)。比较两组患者术后1、3、6、9、12个月时健康相关生命质量SF-12量表中的生理总评分(PCS)和心理总评分(MCS)、骨折愈合时间、携带外固定支架时间、并发症发生率、Johner-Wruh胫骨干骨折疗效评估的优良率及下肢功能评分(LEFS)。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。两组患者治疗后至少随访12个月,A组患者的PCS、MCS均于术后12个月均达到峰值,B组患者的PCS、MCS分别于术后6、3个月达到峰值。A组患者术后6、9、12个月的PCS、MCS均高于B组,骨折愈合时间(19.2±4.6)周]短于B组(23.3±5.6)周],携带外固定支架时间(15.6±4.2)d]短于B组(270.0±15.4)d],并发症发生率5.7%(2/35)]低于B组35.3%(6/17)],术后12个月LEFS评分(88.3±7.2)分]高于B组(78.5±5.2)分],Johner-Wruh胫骨干骨折疗效评估的优良率94.3%(33/35)]高于B组70.6%(12/17)],差异均有统计学意义(P<0.05)。结论与外固定支架行终末治疗相比较,拆除外固定支架后更换为内固定治疗胫腓骨开放性骨折可明显改善患者的健康相关生命质量及功能,并能有效减少术后并发症的发生。

Effects of external fixation as a terminal versus staged treatment on prognosis in patients with open tibiofibular fracture

Objective To compare the effects of external fixation as a terminal versus staged treat-ment on the health-related quality of life and function in patients with open tibiofibular fracture.Methods From March 2017 to October 2018,52 patients with open tibiofibular fracture were admitted to Department of Orthopaedic Surgery,Honghui Hospital.They were 37 males and 14 females,aged from 19 to 62 years(mean,39.9 years).They were assigned into 2 groups subjected to 2 different treatment plans.In group A of 35 cases primary external fixation was replaced by terminal internal fixation while in group B of 17 cases primary ex-ternal fixation continued to the end.The 2 groups were compared in terms of the physiological total score(PCS)and mental component summary(MCS)in the 12-item short-form health survey(SF-12)at 1,3,6,9 and 12 months postoperation,fracture healing time,time for external fixation,incidence of complications,and the lower extremity functional scale(LEFS).Results The 2 groups were compatible due to insignificant differences in the general clinical data(P>0.05).The follow-ups for the 2 groups were all beyond 12 months.PCS and MCS peaked both at 12 months postoperation in group A,but peaked respectively at 6 and 3 months postoperation in group B.Compared with group B,group A showed significantly higher PCS and MCS at 6,9 and 12 months postoperation,significantly shorter fracture healing time(19.2 weeks±4.6 weeks versus 23.3 weeks±5.6 weeks),significantly shorter time for external fixation(15.6 days±4.2 days versus 270.0 days±15.4 days),significantly lower incidence of complications5.7%(2/35)versus 35.3%(6/17)],significantly higher LEFS scores(88.3±7.2 versus 78.5±5.2),and significantly higher the excellent and good rate by the Johner-Wruh scoring94.3%(33/35)versus 70.6%(12/17)](all P<0.05).Conclusion Compared with external fixation as a terminal treatment,external fixation followed by internal fixation can significantly improve the health-related quality of life and function in patients with open tibiofibular fracture and effectively reduce the incidence of postoperative complications.