Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
Department of Prosthodontics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
Injury. 2021 Nov;52(11):3478-3482. doi: 10.1016/j.injury.2021.01.018. Epub 2021 Jan 14.
Postoperative malalignment in fractures treated by monolateral external fixation is not uncommon in clinical practice. Accurate reduction without excessive tissue disruption caused by surgical intervention and sequentially manage the fractures using monolateral external fixation for definitive treatment is still a challenge for surgeons. The purpose of our study was to evaluate the feasibility and effectiveness of the temporary application of the hexapod external fixator (HEF) for the postoperative malalignment correction in tibial diaphyseal fractures treated by monolateral external fixation.
We carried out a retrospective analysis of 23 trauma patients with tibial diaphyseal fracture treated by the monolateral external fixation at our institution from January 2016 to May 2019. There were 21 males and 2 females with a mean age of 38 years (range 18-60 years). The hexapod external fixator was temporarily applied due to postoperative malalignment within two weeks and who unwilling to undergo a secondary surgical intervention. For patients with postoperative malalignment requiring correction, the HEF components were installed on the original existing half pins of the monolateral external fixator after removing the connecting rod. The standard anteroposterior and lateral X-rays of the injured limb combined with the temporary HEF were conducted to measure the hexapod external fixator parameters. Any residual deformities were corrected by gradual struts adjustment with the aid of computer-based software. When satisfactory alignment was achieved, the HEF was removed, and the monolateral external fixator was sequentially used as the definitive structure.
All patients acquired functional reduction, which was evaluated by radiographs. The mean correction time was 4 days (range 2 to 8 days). The mean coronal plane translation (1.3±1.0 mm), coronal plane angulation (0.9±0.7°), sagittal plane translation (1.4±1.1 mm), and sagittal plane angulation (0.7±0.7°) after correction were all less than those (7.0±4.9 mm, 4.7±2.3°, 5.6±3.6 mm, 3.2±2.5°) before correction.
The temporary application of the hexapod external fixator is an alternative and feasible method for the postoperative malalignment correction in tibial diaphyseal fractures treated by monolateral external fixation.
在临床实践中，单侧外固定器治疗的骨折术后对线不良并不少见。对于外科医生来说，准确地复位，同时避免手术干预造成的过度组织损伤，并使用单侧外固定器进行序贯固定治疗，仍然是一个挑战。我们的研究目的是评估六足外固定器（HEF）在治疗单侧外固定器治疗的胫骨骨干骨折术后对线不良中的应用的可行性和有效性。
我们对 2016 年 1 月至 2019 年 5 月我院收治的 23 例胫骨骨干骨折患者进行了回顾性分析，这些患者均采用单侧外固定器治疗。其中男性 21 例，女性 2 例，平均年龄 38 岁（18-60 岁）。术后两周内出现对线不良且不愿意接受二次手术干预的患者，临时应用六足外固定器。对于需要矫正的术后对线不良患者，在去除连接杆后，将 HEF 组件安装在单侧外固定器的原有半钉上。通过受伤肢体的标准前后位和侧位 X 线片结合临时 HEF 测量六足外固定器的参数。通过计算机软件辅助逐渐调整支柱来矫正任何残余畸形。当达到满意的对线后，去除 HEF，然后使用单侧外固定器作为最终结构。
所有患者均通过影像学评估获得了功能复位。平均矫正时间为 4 天（2-8 天）。矫正后冠状面平移（1.3±1.0mm）、冠状面成角（0.9±0.7°）、矢状面平移（1.4±1.1mm）和矢状面成角（0.7±0.7°）均小于矫正前的（7.0±4.9mm、4.7±2.3°、5.6±3.6mm、3.2±2.5°）。
临时应用六足外固定器是治疗单侧外固定器治疗的胫骨骨干骨折术后对线不良的一种替代且可行的方法。
