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开放性胫骨骨折外固定后马蹄足畸形的预防：巴黎石膏后托与被动踝关节物理治疗的比较

Prevention of Equinus Deformity after External Fixation for Open Tibia Fractures: A Comparison between Plaster of Paris Backslab and Passive Ankle Physiotherapy.

作者信息

Lartey Samuel Quarshie, Holdbrook-Smith Henry, Baddoo Daniel Tettey, Ocloo Agbeko, Gudugbe Senyo

机构信息

Orthopedics and Trauma Unit, Korle Bu Teaching Hospital, Accra, Ghana.

Orthopaedics Unit, Holy Family Hospital, Techiman, Bono East, Ghana.

出版信息

J West Afr Coll Surg. 2024 Jan-Mar;14(1):102-108. doi: 10.4103/jwas.jwas_87_23. Epub 2023 Dec 14.

DOI:10.4103/jwas.jwas_87_23
PMID:38486644
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10936882/
Abstract

BACKGROUND

Ankle equinus deformity is a common complication of prolonged external fixator use in tibia fractures with an incidence of 15%-16%. It affects gait and may lead to foot, leg, and back problems. Treatment of equinus deformity increases the cost of treatment of open tibia fractures and increases the time spent off work. Several preventive modalities have been suggested in literature with variable success, but no standard protocol exists.

OBJECTIVES

The aim of this study was to determine the most appropriate method of preventing equinus deformity of the ankle joint during the management of open tibia fractures with unilateral uniplanar external fixators by comparing plaster of paris (POP) backslab application with passive ankle physiotherapy using strips of car tyre inner tubing.

MATERIALS AND METHODS

The study was a prospective randomised study involving patients with open tibia fractures who were managed with external fixators at the Korle Bu Teaching Hospital between April 2020 and February 2021. Patients were randomised into two groups; one group had below knee POP backslab and the other group did passive ankle physiotherapy using a strip of car tyre inner tubing. The passive ankle range of motion was measured at the beginning and after 6 weeks using a goniometer.

RESULTS

Fifty-six participants were recruited with 29 in the POP backslab group and 27 in the ankle physiotherapy group. The median age was 35.0 years. Male-to-female ratio was 4.6:1. Motor vehicle crash contributed to over 90% with 42.9% being motorbike riders. Initial and final mean ankle measurements for the POP backslab group were 6.79° and 10.14° for dorsiflexion and 29.93° and 34.52° for plantarflexion, respectively. The ankle physiotherapy group had initial and final dorsiflexion of 7.19° and 12.85° and plantarflexion of 30.44° and 34.52°, respectively. The ankle physiotherapy group had a better range of motion (47.37°) than the POP group (40.66°) with a value of 0.008. One participant (3.7%) from the ankle physiotherapy group had equinus deformity compared with seven (24%) from the POP backslab group, a difference which gives a value of 0.029.

CONCLUSIONS

Passive ankle physiotherapy with car tyre inner tube is a better and cheaper modality of preventing ankle equinus deformity and maintaining ankle range of motion.

摘要

背景

踝关节马蹄畸形是胫骨骨折长期使用外固定器常见的并发症，发生率为15%-16%。它影响步态，并可能导致足部、腿部和背部问题。马蹄畸形的治疗增加了开放性胫骨骨折的治疗成本，并增加了误工时间。文献中提出了几种预防方法，但效果不一，且尚无标准方案。

目的

本研究的目的是通过比较应用巴黎石膏（POP）后托与使用汽车轮胎内胎条进行被动踝关节物理治疗，确定在使用单侧单平面外固定器治疗开放性胫骨骨折期间预防踝关节马蹄畸形的最合适方法。

材料与方法

本研究为前瞻性随机研究，纳入2020年4月至2021年2月在科勒布教学医院接受外固定器治疗的开放性胫骨骨折患者。患者被随机分为两组；一组接受膝下POP后托，另一组使用汽车轮胎内胎条进行被动踝关节物理治疗。在开始时和6周后使用量角器测量被动踝关节活动范围。

结果

共招募了56名参与者，其中POP后托组29名，踝关节物理治疗组27名。中位年龄为35.0岁。男女比例为4.6:1。机动车碰撞导致的骨折超过90%，其中42.9%为摩托车骑手。POP后托组初始和最终踝关节背屈平均测量值分别为6.79°和10.14°，跖屈分别为29.93°和34.52°。踝关节物理治疗组初始和最终背屈分别为7.19°和12.85°，跖屈分别为30.44°和34.52°。踝关节物理治疗组的活动范围（47.37°）优于POP组（40.66°），P值为0.008。踝关节物理治疗组有1名参与者（3.7%）出现马蹄畸形，而POP后托组有7名（24%），差异的P值为0.029。

结论

使用汽车轮胎内胎进行被动踝关节物理治疗是预防踝关节马蹄畸形和维持踝关节活动范围的更好且更经济的方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32c0/10936882/c01c3ad0b215/JWACS-14-102-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32c0/10936882/7c494a0d2e47/JWACS-14-102-g001.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32c0/10936882/d5b42f652cba/JWACS-14-102-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32c0/10936882/c01c3ad0b215/JWACS-14-102-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32c0/10936882/7c494a0d2e47/JWACS-14-102-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32c0/10936882/b5ad37966e44/JWACS-14-102-g002.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32c0/10936882/c01c3ad0b215/JWACS-14-102-g007.jpg

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本文引用的文献

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Equinus and Lengthening Techniques.马蹄足及延长技术。
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The Split Second Effect: The Mechanism of How Equinus Can Damage the Human Foot and Ankle.瞬间效应：马蹄足如何损伤人足和踝关节的机制
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Motorcycle accidents: morbidity and associated factors in a city of northeast of Brazil.摩托车事故：巴西东北部某城市的发病率及相关因素
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Traumatic injury among females: does gender matter?女性的创伤性损伤：性别有影响吗？
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