| 个体化可控性应力外固定技术在胫骨开放性骨折中的应用 |
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Received:December 20, 2020
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| 作者 | Author | 单位 | Unit | E-Mail |
| 衡德忠 |
HENG De-zhong |
黄河三门峡医院创伤骨科, 河南 三门峡 472000 |
Department of Traumatology and Orthopaedics, Yellow River Sanmenxia Hospital, Sanmenxia 472000, Henan, China |
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| 李静 |
LI Jing |
黄河三门峡医院创伤骨科, 河南 三门峡 472000 |
Department of Traumatology and Orthopaedics, Yellow River Sanmenxia Hospital, Sanmenxia 472000, Henan, China |
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| 翟江波 |
ZHAI Jiang-bo |
黄河三门峡医院创伤骨科, 河南 三门峡 472000 |
Department of Traumatology and Orthopaedics, Yellow River Sanmenxia Hospital, Sanmenxia 472000, Henan, China |
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| 贾海丽 |
JIA Hai-li |
黄河三门峡医院创伤骨科, 河南 三门峡 472000 |
Department of Traumatology and Orthopaedics, Yellow River Sanmenxia Hospital, Sanmenxia 472000, Henan, China |
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| 周羿辰 |
ZHOU Yi-chen |
黄河三门峡医院创伤骨科, 河南 三门峡 472000 |
Department of Traumatology and Orthopaedics, Yellow River Sanmenxia Hospital, Sanmenxia 472000, Henan, China |
537504020@qq.com |
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| 期刊信息：《中国骨伤》2021年34卷，第10期，第915-919页 |
| DOI：10.12200/j.issn.1003-0034.2021.10.006 |
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目的：研究个体化可控性应力外固定架在治疗胫骨开放性骨折时的临床疗效。
方法：2018年12月至2020年7月收治60例胫骨开放性骨折患者，男35例，女25例；年龄23~58岁；病程1.2~10.0 h。根据术后对骨折端应力刺激的大小将其分为4组，其中包括无应力组（15例）及不同应力刺激的3组（各组15例）。所有胫骨开放骨折患者行可控性应力外固定支架手术治疗，术后4周，应力组以患者体重为参考，调节弹性外固定架向骨折端施加自身体重1/6、2/6、3/6的轴向应力。观察所有患者术后伤口愈合情况，随访术后4、6、8、10、12周时骨折断端平扫CT图片，计算每10个扫描平面骨痂面积的平均值，比较各组间的差异。观察终末随访患者的骨折愈合情况，并进行统计学分析。
结果：术后所有患者伤口愈合良好，其中有7例Ⅱ期行游离植皮及转移肌皮瓣手术。所有患者获得随访，时间12~24个月，平均16.5个月。终末随访结果显示应力组和无应力组的骨折愈合比较差异有统计学意义（P<0.05）。给予骨折端轴向应力刺激后，4、6、8、10、12周对所有患者骨折断端行CT检查，计算10个平扫平面骨痂面积的平均值分别为：无应力组（0.275±0.092）、（0.383±0.051）、（0.412±0.048）、（0.472±0.019）、（0.548±0.036）mm2，应力组的骨痂长入面积值明显高于无应力组，通过比较各组数据差异有统计学意义（P<0.05）。
结论：采用可控性应力外固定技术治疗胫骨开放性骨折时，4周后根据患者自身体重调节弹性外固定架，予骨折端施加一定的轴向应力，有利于患者骨折的愈合，可以降低开放性骨折骨延迟愈合或不愈合的发生率，具有一定的应用价值。 |
| [关键词]:外固定器 胫骨骨折 骨折,开放性 骨痂 骨折,不愈合 |
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| Application of individualized controllable stress external fixation in open tibial fractures |
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Abstract:
Objective: To study the clinical effect of individualized controllable stress external fixator in the treatment of open tibial fractures.
Methods: From December 2018 to July 2020,60 patients with open tibial fractures were treated,including 35 males and 25 females;The age ranged from 23 to 58 years;The course of disease was 1.2 to 10.0 h. According to the stress stimulation on the fracture end after operation,all patients were divided into 4 groups,including non stress group (15 cases) and 3 groups with different stress stimulation(15 cases in each group). All patients with open tibial fractures were treated with controllable stress external fixator. Four weeks after operation,the stress group adjusted the elastic external fixator to apply axial stress of 1/6,2/6 and 3/6 of their own weight to the fracture end based on the patient's weight. The wound healing of all patients after operation was observed,the plain CT images of fracture ends at 4,6,8,10 and 12 weeks after operation were followed up,the average value of callus area per 10 scanning planes was calculated,and the differences between the groups were compared. The fracture healing was observed and statistically analyzed.
Results: The wounds of all patients healed well,of which 7 patients underwent secondary free skin grafting and transferred myocutaneous flap. All patients were followed up for 12 to 24 months,with an average of 16.5 months. The final follow-up results showed that the fracture healing of stress groups and non stress group had significant difference(P<0.05). After axial stress stimulation at the fracture end,CT examination was performed on the fracture end of all patients at 4,6,8,10 and 12 weeks. The average values of callus area in 10 plain scanning planes were calculated as follows:no stress group(0.275±0.092) mm2,(0.383±0.051) mm2,(0.412±0.048) mm2,(0.472±0.019) mm2,(0.548±0.036) mm2,the area of callus growth in the stress group was significantly higher than that in the non stress group. There was significant difference among these groups(P<0.05).
Conclusion: When the controllable stress external fixation technique is used to treat open tibial fractures,the elastic external fixator is adjusted according to the patient's own weight after 4 weeks,and a certain axial stress is applied to the fracture end,which is conducive to the fracture healing of patients,and can reduce the incidence of delayed union or nonunion of open fractures,which has a certain application value. |
| KEYWORDS:External fixators Tibial fractures Fractures,open Bone,callus Fractures,ununited |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 衡德忠,李静,翟江波,贾海丽,周羿辰.个体化可控性应力外固定技术在胫骨开放性骨折中的应用[J].中国骨伤,2021,34(10):915~919 |
| 英文格式: | HENG De-zhong,LI Jing,ZHAI Jiang-bo,JIA Hai-li,ZHOU Yi-chen.Application of individualized controllable stress external fixation in open tibial fractures[J].zhongguo gu shang / China J Orthop Trauma ,2021,34(10):915~919 |
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