Luo Xiande, Duan Kuan, Qin Renlei, Zhang Yisheng
Department of Joint Trauma, the First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning Guangxi, 530000, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020 Sep 15;34(9):1101-1105. doi: 10.7507/1002-1892.202002101.
To explore the application value of lithotomy position in the treatment of tibial shaft fracture with closed reduction and interlocking intramedullary nail fixation.
The clinical data of 78 patients with tibial shaft fractures treated with closed reduction and interlocking intramedullary nail fixation between January 2015 and May 2018 were retrospectively analyzed. Among them, 33 patients were treated with lithotomy position (trial group) and 45 patients were treated with traditional supine position (control group). There was no significant difference between the two groups in general data such as gender, age, the cause of injury, the interval between injury and admission, the interval between injury and operation, and fracture type and site ( >0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy times, the number of patients with open reduction, postoperative incision infection, and fracture healing were recorded. Pain visual analogue scale (VAS) score and Harris score were used to evaluate the effectiveness.
Both groups of operations were successfully completed. The trial group was superior to the control group in terms of operation time, intraoperative blood loss, intraoperative fluoroscopy times, and the number of patients with open reduction ( <0.05). Incision infection occurred in 1 case (3.03%) of the trial group and 3 cases (6.67%) of the control group after operation. The difference in the incidence of infection was significant ( =0.139, =0.045). The incisions of other patients healed by first intention. X-ray film reexamination showed that the fractures of the two groups healed. The fracture healing time of the trial group was (5.30±1.33) months, while that of the control group was (5.98±1.80) months, with no significant difference ( =-1.815, =0.073). There was no significant difference in VAS score, Harris scores of knee joint and ankle joint between the two groups before operation and at 3, 6, and 12 months after operation ( >0.05). At 3 days after operation, the VAS score was lower in the trial group than in the control group, and the Harris scores of knee joint and ankle joint were higher in the trial group than in the control group, and the differences were significant ( <0.05).
Application of lithotomy position in closed reduction and interlocking intramedullary nail fixation for tibial shaft fracture is favorable for fracture reduction, with less bleeding, shorter operation time, and fewer fluoroscopy.
探讨截石位在闭合复位交锁髓内钉固定治疗胫骨干骨折中的应用价值。
回顾性分析2015年1月至2018年5月采用闭合复位交锁髓内钉固定治疗的78例胫骨干骨折患者的临床资料。其中，33例采用截石位治疗（试验组），45例采用传统仰卧位治疗（对照组）。两组在性别、年龄、受伤原因、受伤至入院间隔时间、受伤至手术间隔时间、骨折类型及部位等一般资料方面比较，差异无统计学意义（>0.05）。记录手术时间、术中出血量、术中透视次数、切开复位患者例数、术后切口感染情况及骨折愈合情况。采用疼痛视觉模拟评分（VAS）和Harris评分评估疗效。
两组手术均顺利完成。试验组在手术时间、术中出血量、术中透视次数及切开复位患者例数方面均优于对照组（<0.05）。术后试验组有1例（3.03%）发生切口感染，对照组有3例（6.67%）发生切口感染。感染发生率差异有统计学意义（=0.139，=0.045）。其他患者切口均一期愈合。X线片复查显示两组骨折均愈合。试验组骨折愈合时间为（5.30±1.33）个月，对照组为（5.98±1.80）个月，差异无统计学意义（=-1.815，=0.073）。两组术前及术后3、6、12个月的VAS评分、膝关节及踝关节Harris评分比较，差异无统计学意义（>0.05）。术后3天，试验组VAS评分低于对照组，试验组膝关节及踝关节Harris评分高于对照组，差异有统计学意义（<0.05）。
截石位应用于胫骨干骨折闭合复位交锁髓内钉固定有利于骨折复位，出血少，手术时间短，透视次数少。
