Zhou Shang-Qing, Zhang Qi, Ding Xiang-Dong, Qin Yin-Yin, Cai San
Department of Orthopaedics, Chongqing Public Health Medical Center, Chongqing 400030, China.
Zhongguo Gu Shang. 2021 May 25;34(5):400-5. doi: 10.12200/j.issn.1003-0034.2021.05.003.
To explore clinical effect of locking plate external fixation combined with membrane induction technology in treating open and comminuted tibial fractures with bone defects.
Totally 92 patients of open and comminuted tibial fractures with bone defects were chosen form January 2018 to July 2019, and randomly divided into external fixation group and internal fixation group, 46 patients in each group. In external fixation group, there were 29 males and 17 females, aged from 25 to 62 years old, with an average of (37.45±10.92) years old;according to AO classification, 15 patients were type A, 22 patients were type B and 9 patients were type C;according to Gustilo classification, 21 patients were typeⅡ, 10 patients were type ⅢA, 10 patients were type ⅢB, 5 patients were type Ⅲ C;treated by fracture reduction with locking plate external fixation. In internal fixation group, there were 31 males and 15 females, aged from 23 to 60 years old, with an average of(36.88±10.64) years old;according to AO classification, 18 patients were type A, 20 patients were type B and 8 patients were type C; according to Gustilo classification, 22 patients were typeⅡ, 11 patients were type ⅢA, 7 patients were type ⅢB, 6 patients were type Ⅲ C;treated by traditional open reduction with plate internal fixation. Operation time, intraoperative blood loss, incision length, hospital stay, fracture healing time and lower limb full weight-bearing time and postoperative complications between two groups were observed and compared, bone mineral density, osteocalcin, blood calcium and phosphorus before operation and 1 month after operation.
All patients were followed up from 12 to 18 months with an average of (14.92±2.46) months. Operation time, intraoperative blood loss, incision length, hospital stay, fracture healing time and lower limb full weight-bearing time of external fixation group were significantly better than that of internal fixation group(<0.05). Postoperative bone mineral density, osteocalcin, blood calcium and phosphorus at 1 month in external group were higher than that of internal fixation group (<0.05). Four patients in external fixation group occurred complications, 13 patients in internal fixtaion group, and occurrence rate of complications in external fixation group (8.70%) was lower than that of internal fixtaion group (28.26%)(=4.618, =0.032).
Locking plate external fixation combined with membrane induction technology in treating open and comminuted tibial fractures with severe post-traumatic bone defects has advantages of less trauma, reliable fixation, shorter fracture healing time, and could improve bone metabolic activity with less postoperative complications.
探讨锁定钢板外固定联合膜诱导技术治疗开放性粉碎性胫骨骨折伴骨缺损的临床效果。
选取2018年1月至2019年7月收治的92例开放性粉碎性胫骨骨折伴骨缺损患者，随机分为外固定组和内固定组，每组46例。外固定组男29例，女17例，年龄25～62岁，平均（37.45±10.92）岁；按AO分型：A型15例，B型22例，C型9例；按Gustilo分型：Ⅱ型21例，ⅢA型10例，ⅢB型10例，ⅢC型5例；采用锁定钢板外固定复位骨折治疗。内固定组男31例，女15例，年龄23～60岁，平均（36.88±10.64）岁；按AO分型：A型18例，B型20例，C型8例；按Gustilo分型：Ⅱ型22例，ⅢA型11例，ⅢB型7例，ⅢC型6例；采用传统切开复位钢板内固定治疗。观察比较两组手术时间、术中出血量、切口长度、住院时间、骨折愈合时间、下肢完全负重时间及术后并发症，术前及术后1个月骨密度、骨钙素、血钙、血磷。
所有患者随访12～18个月，平均（14.92±2.46）个月。外固定组手术时间、术中出血量、切口长度、住院时间、骨折愈合时间及下肢完全负重时间均明显优于内固定组（P<0.05）。外固定组术后1个月骨密度、骨钙素、血钙、血磷高于内固定组（P<0.05）。外固定组4例发生并发症，内固定组13例，外固定组并发症发生率（8.70%）低于内固定组（28.26%）（χ²=4.618，P=0.032）。
锁定钢板外固定联合膜诱导技术治疗开放性粉碎性胫骨骨折伴严重创伤后骨缺损具有创伤小、固定可靠、骨折愈合时间短的优点，能提高骨代谢活性，术后并发症少。
