Borah Pranab Jyoti, Patowary Chandan, Das Abhijit, Shirdinayak Tirupati Shivanand, Roy Jyoti Prakash, Kumar Sourabh
Assam Medical College and Hospital, Dibrugarh, B-103, Amar Basha-II, 826-Jhilpar Road, Mahamayatala, PO:Garia, Kolkata, 700084 India.
Indian J Orthop. 2022 Sep 8;56(11):2006-2012. doi: 10.1007/s43465-022-00727-z. eCollection 2022 Nov.
Because one-third of the tibia is subcutaneous throughout most of its length and its location, it is more prone to open fractures. Open distal tibia fractures are mostly due to RTA and sports injuries. The goal of treatment is to obtain a healed, well-aligned fracture; pain-free weight-bearing; and functional range of motion of the knee and ankle.
33 patients of the 18-60-year age group with open distal tibia extra-articular fractures (without vascular injury), less than 3 weeks old trauma were included in the prospective study for 1 year period (1st June 2019 to 31st May 2020). 17 cases were treated with the Hybrid external fixator (HEF) and 16 cases were treated with the Ilizarov fixator (IF).
Significantly ( < 0.05), the mean duration of surgery was less in the HEF group (67.6 min), faster union of open type-II fractures in the HEF group (16.4 weeks), and also a higher AOFAS score at 6 months in open type-II fractures in the HEF group (84.4). There were two cases of equinus deformity in the IF group and one case of valgus deformity in the HEF group.
HEF and IF are both equally effective in the treatment of open distal tibia extra-articular fractures with the advantage of stable fracture fixation, early weight-bearing, preserving soft tissue, minimal periosteal stripping, and providing one-staged definitive intervention. However, HEF is preferred over IF in terms of less operating time, faster union, and a better functional outcome with minimal complications.
由于胫骨三分之一的长度在大部分行程中位于皮下且位置表浅,因此更容易发生开放性骨折。胫骨远端开放性骨折大多由道路交通伤(RTA)和运动损伤所致。治疗的目标是使骨折愈合、对线良好;实现无痛负重;以及恢复膝关节和踝关节的功能活动范围。
前瞻性研究纳入了33例年龄在18至60岁之间、患有胫骨远端开放性关节外骨折(无血管损伤)且受伤时间少于3周的患者,研究为期1年(2019年6月1日至2020年5月31日)。17例患者采用混合外固定器(HEF)治疗,16例患者采用伊里扎洛夫固定器(IF)治疗。
显著差异(<0.05)显示,HEF组的平均手术时间较短(67.6分钟),HEF组开放性II型骨折的愈合速度更快(16.4周),并且HEF组开放性II型骨折在6个月时的美国足踝外科协会(AOFAS)评分更高(84.4)。IF组有2例马蹄足畸形病例,HEF组有1例外翻畸形病例。
HEF和IF在治疗胫骨远端开放性关节外骨折方面同样有效,具有骨折固定稳定、早期负重、保护软组织、骨膜剥离最少以及提供一期确定性干预等优点。然而,在手术时间更短、愈合更快以及功能结果更好且并发症最少方面,HEF优于IF。