Department of Trauma and Microreconstructive Surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
Department of Orthopedics, Shanghai Pudong New Area People's Hospital, Shanghai, China.
BMC Musculoskelet Disord. 2022 Apr 8;23(1):330. doi: 10.1186/s12891-022-05257-1.
External fixation, which can preserve the biomechanical microenvironment of fracture healing, plays an important role in managing the high-energy fractures with poor surrounding soft tissues. The purpose of this study was to determine the differences of clinical outcomes, if any, between hexapod external fixator and monolateral external fixator in the definitive treatment of high-energy tibial diaphyseal fractures.
A total of 53 patients with high-energy tibial diaphyseal fractures and definitively treated by the hexapod external fixator (HEF) or monolateral external fixator (MEF) were retrospectively collected and analyzed, from March 2015 to June 2019. There were 31 patients in the HEF treatment, and the other 22 patients were managed by the MEF. The demographic data, surgical duration, external fixation time, final radiological results, complications, and clinical outcomes were documented and analyzed. Difficulties that occurred during the treatment were classified according to Paley. The clinical outcomes were evaluated by the Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) at the last clinical visit.
The mean surgical duration in the HEF group (62.4 ± 8.3 min) was shorter than that in the MEF group (91.4 ± 6.9 min) (P < 0.05). All patients acquired complete bone union finally. Patients in the HEF group (24.2 ± 3.1 weeks) underwent a shorter average external fixation time than that in the MEF group (26.3 ± 3.8 weeks) (P < 0.05). Satisfactory alignment was achieved in all patients without the need for remanipulation. The residual sagittal plane deformities in the HEF group were all less than that in the MEF group (P < 0.05). The complication rate was 35.5% in the HEF group, while 45.5% in the MEF group. There was no statistically significant difference between the two groups in ASAMI scores (P > 0.05).
There is no statistically significant difference in finally clinical outcomes between hexapod external fixator and monolateral external fixator in the definitive treatment of high-energy tibial diaphyseal fractures. The hexapod external fixation treatment is a superior effective method, including advantages of stable fixation, less surgical duration, postoperatively satisfactory fracture reduction, and fewer complications.
外固定架可以维持骨折愈合的生物力学微环境，在外固定架固定治疗高能伴软组织损伤胫骨骨折中发挥重要作用。本研究旨在比较六轴外固定架与单臂外固定架在高能胫骨骨干骨折最终治疗中的临床疗效差异。
回顾性分析 2015 年 3 月至 2019 年 6 月采用六轴外固定架（HEF）或单臂外固定架（MEF）治疗的 53 例高能胫骨骨干骨折患者的临床资料。其中 HEF 组 31 例，MEF 组 22 例。记录并比较两组患者的一般资料、手术时间、外固定时间、最终影像学结果、并发症及临床疗效。根据 Paley 分类标准对治疗过程中遇到的困难进行分类。末次随访时采用伊利扎洛夫应用研究协会（ASAMI）标准评估临床疗效。
HEF 组的手术时间（62.4±8.3）min 短于 MEF 组（91.4±6.9）min（P<0.05）。所有患者均获得完全骨愈合。HEF 组的平均外固定时间（24.2±3.1）周短于 MEF 组（26.3±3.8）周（P<0.05）。所有患者均获得满意的对线，无需再次矫形。HEF 组矢状面残余畸形均小于 MEF 组（P<0.05）。HEF 组并发症发生率为 35.5%，MEF 组为 45.5%，两组间差异无统计学意义（P>0.05）。HEF 组 ASAMI 评分优良率为 83.9%，MEF 组为 86.4%，两组间差异无统计学意义（P>0.05）。
在高能胫骨骨干骨折的最终治疗中，六轴外固定架与单臂外固定架的临床疗效差异无统计学意义。六轴外固定架治疗具有固定稳定、手术时间短、术后骨折复位满意、并发症少等优点。
