伊利扎洛夫外固定治疗胫骨节段性骨折的管理

Makhdoom Asad Ullah, Shaikh Babar Jan, Baloch Raheel Akbar, Malah Hamid Raza, Tunio Zamir Hussain, Jokhio Muhammad Faraz

Department of Orthopaedic Surgery & Traumatology, Liaquat university of Medical & Health Sciences Jamshoro, Sindh, Pakistan.

J Ayub Med Coll Abbottabad. 2020 Jul-Sep;32(3):291-294.

BACKGROUND

Tibial shaft segmental fractures are mostly occurring due to a high-energy trauma that produces a severe soft-tissue injury and resulting an excessive frequency of open and closed segmental fractures, and needs effective stable management. The objective of the study was to evaluate the functional outcome and union time in segmental tibial fracture treated with Ilizarov method.

METHODS

This prospective Qausi-experimental study was carried out from March 2014 to February 2018. Total 45 patients were included (36 males, 09 females) with a mean age of 30 years (range 20-50) with segmental tibial fractures either closed or open without any gender bar, were stabilized with an Ilizarov method. Functional outcome and bone union was assessed by ASAMI criteria. Patients were followed up to 18 months. SPSS-21.0 was used to calculate the descriptive statistics and t-test of difference between union time in open and close fractures.

RESULTS

According to Gustilo classification for open fractures, there were Grade IIIA 21 (67.7%), Grade IIIB 10 (32.2%). According to AO classification for closed fractures; 42-C1 type fractures were 5 (35.7%), 42-C2 was 6 (42.8%), 42-C3 was 3 (21.4%). Based on ASAMI criteria for bone assessment; excellent results in 26 (57.8%), good results in 16 (35.5%) and fair results in 3 (6.6%) and functional outcome was 29 (64.4%) excellent, 12 (26.6%) good and 4 (8.8%) fair was obtained. Union time difference was examined using t-statistics and score of p was greater than 0.05. This result was expected as an average time of union was almost similar in both groups, i.e., 19.83, ±11.92 in close and 20.73, ±9.09 within an open group. Overall, the union time was minimum 10.86, maximum 45.14, and median was 20.29.

CONCLUSIONS

Ilizarov is an effective method for the stabilization of segmental tibial fractures because the method allows close reduction without extensive soft tissue damage and is efficient for the stabilization of short distal segmental fractures of the tibia.

背景

胫骨干节段性骨折大多由高能创伤所致，会造成严重的软组织损伤，导致开放性和闭合性节段性骨折的发生率过高，因此需要有效的稳定治疗。本研究的目的是评估采用伊里扎洛夫方法治疗胫骨干节段性骨折的功能结果和愈合时间。

方法

本前瞻性半实验性研究于2014年3月至2018年2月进行。共纳入45例患者（男36例，女9例），平均年龄30岁（范围20 - 50岁），患有闭合性或开放性胫骨干节段性骨折，无性别限制，采用伊里扎洛夫方法进行固定。根据ASAMI标准评估功能结果和骨愈合情况。对患者进行了18个月的随访。使用SPSS - 21.0计算描述性统计数据以及开放性骨折和闭合性骨折愈合时间差异的t检验。

结果

根据开放性骨折的 Gustilo 分类，ⅢA级21例（67.7%），ⅢB级10例（32.2%）。根据闭合性骨折的AO分类；42 - C1型骨折5例（35.7%），42 - C2型6例（42.8%），42 - C3型3例（21.4%）。根据ASAMI标准进行骨评估；结果优秀26例（57.8%），良好16例（35.5%），一般3例（6.6%），功能结果为优秀29例（64.4%），良好12例（26.6%），一般4例（8.8%）。使用t统计量检验愈合时间差异，p值大于0.05。这一结果在意料之中，因为两组的平均愈合时间几乎相似，即闭合性骨折组为19.83±11.92，开放性骨折组为20.73±9.09。总体而言，愈合时间最短为10.86，最长为45.14，中位数为20.29。