Department of Sports Medicine, Pt. BD Sharma PGIMS, Rohtak, India.
Department of Orthopedics, Pt. BD Sharma PGIMS, Rohtak, India.
Injury. 2022 Oct;53(10):3464-3470. doi: 10.1016/j.injury.2022.08.020. Epub 2022 Aug 9.
Management of open fractures of tibia is still a matter of debate due to high incidence of infections. Traditionally external fixators have been advocated in managing open tibial fractures. Due to limited efficacy of systemic antibiotics, recently antibiotic coated intramedullary interlocking nails have been developed for the management of open tibia fractures. Therefore, we conducted this prospective randomized study to compare the functional and radiological outcomes of primary ring fixator versus antibiotic coated nail in open diaphyseal tibial fractures.
The study included 32 patients with Gustilo-Anderson type II and type IIIA fractures of tibial diaphysis. Out of them 16 patients were managed with Ring External Fixator (Group I) and 16 were managed with Ossipro gentamicin intramedullary interlocking tibial nail (Group II). The radiological and functional outcomes were assessed at final follow-up according to and SMFA criteria. Statistical analysis of the data was performed using IBM SPSS statistics 2.0 software. Chi square test and independent student t-test were used and a P value <0.05 was considered statistically significant RESULTS: Union was achieved in 15 patients (93.8%) in group I and 13 patients (81.2%) in group II. Pin tract infection was seen in 6 patients (37.5%) in group I, whereas infection was present in 2 patients (12.5%) in group II. Bone results were excellent in 13 patients (81.3%), good in 2 patients (12.5%), poor in one patient (6.3%). In group II, bone results were excellent in 12 patients (75%), good in one patient (6.2%), poor in 3 patients (18.8%). At 1 year of final follow up, mean SMFA score was 24.41±5.87 in group I, whereas mean SMFA score was 23.703±8.02 in group II.
Ring fixator as well as antibiotic coated tibial interlocking nail achieved comparable rates of union in the present study. Complication rates were similar in both the groups and the functional and radiological outcomes were comparable in both groups. Results of this study indicate that although ring fixation is an established option for management of open tibial fractures, antibiotic-coated intramedullary nail is also a reliable option in open Grade II and grade IIIA injuries.
Level II.
由于感染发生率高，胫骨开放性骨折的治疗仍然存在争议。传统上，外固定架被用于治疗开放性胫骨骨折。由于全身抗生素的疗效有限，最近开发了抗生素涂层交锁髓内钉用于治疗开放性胫骨骨折。因此，我们进行了这项前瞻性随机研究，比较了一期环形固定器与抗生素涂层钉治疗胫骨骨干开放性骨折的功能和影像学结果。
该研究纳入了 32 例 Gustilo-Anderson Ⅱ型和 ⅢA型胫骨骨干开放性骨折患者。其中 16 例患者采用环形外固定架（I 组）治疗，16 例患者采用奥西普林庆大霉素交锁髓内钉（II 组）治疗。根据 SMFA 标准，在最终随访时评估影像学和功能结果。数据的统计分析使用 IBM SPSS statistics 2.0 软件进行。使用卡方检验和独立学生 t 检验，P 值<0.05 被认为具有统计学意义。
I 组 15 例（93.8%）和 II 组 13 例（81.2%）患者达到愈合。I 组有 6 例（37.5%）患者出现钉道感染，而 II 组有 2 例（12.5%）患者出现感染。I 组骨结果优秀 13 例（81.3%），良好 2 例（12.5%），差 1 例（6.3%）。II 组骨结果优秀 12 例（75%），良好 1 例（6.2%），差 3 例（18.8%）。在最终随访 1 年时，I 组的平均 SMFA 评分为 24.41±5.87，而 II 组的平均 SMFA 评分为 23.703±8.02。
在本研究中，环形固定器和抗生素涂层交锁髓内钉的愈合率相似。两组并发症发生率相似，两组的功能和影像学结果相似。该研究结果表明，虽然环形固定是治疗开放性胫骨骨折的一种既定选择，但抗生素涂层交锁髓内钉也是 II 级和 IIIA 级开放性损伤的可靠选择。
II 级。
