单一切口双钢板内固定术结合中药治疗胫腓骨远端骨折的临床观察

发布时间：2018-08-09 10:55

【摘要】：目的：胫腓骨远端骨折是临床上较常见的骨折之一，当腓骨也需要严格固定时，在切开复位内固定治疗中多采用双切口，但是存在诸多问题，双切口往往会造成软组织及骨膜的过度剥离，且要求双切口之间的距离应大于7cm，这样导致软组织的更严重损伤，增加了感染及皮肤坏死的风险。同一切口可同时兼顾胫骨和腓骨的固定，减轻对软组织二次创伤及血运的破坏，减少术后并发症的发生。本研究通过探讨采用单一切口双钢板内固定术配合术后早期口服仙方活命饮在胫腓骨远端骨折治疗中的临床疗效，为胫腓骨远端骨折的早期处理提供一个新的选择。方法：回顾性分析2011年6月至2013年4月武汉市中医医院骨伤科收治的胫腓骨远端骨折患者21例，男15例，女6例，最小年龄28岁，最大年龄68岁。骨折原因:车祸伤13例，跌落伤5例，压伤3例。AO分型:A型11例，B型7例，C型3例。按术后是否使用口服中药分为治疗组（11例）和对照组（10例）。所有患者均由同一组医生在连续硬膜外麻醉下采用小腿前外侧单一切口切开，分别暴露出胫腓骨的骨折断端，复位后予以双钢板固定，，对照组术后予常规处理，治疗组术后除常规处理外加仙方活命饮内服。比较两组患者术后肿胀及疼痛缓解程度。并于术后按Johner-wruh评价标准进行功能评价，观察疗效。结果：所有患者术后均获得随访，随访9-12个月，平均10.6个月。术后第3、7天，对比患者肿胀、疼痛程度，均有显著的统计学差异（p＜0.05）。术后九个月，按Johner-wruh评价标准进行功能评价,优17例，良2例，中2例，差0例，优良率达90.5%。结论：前外侧单一切口可同时进行胫骨和腓骨的固定，能有效降低感染及皮肤坏死的发生率。单一切口双钢板内固定术在应用时操作简便，对软组织损伤较小，并发症少，固定牢靠，疗效确切；仙方活命饮可以有效的缓解术后患肢肿痛，减轻患者的痛苦，为围手术期的处理提供了一种新的选择。
[Abstract]:Objective: distal tibia and fibula fracture is one of the most common fractures in clinic. When fibula is also strictly fixed, double incisions are often used in open reduction and internal fixation, but there are many problems. Double incision often results in excessive exfoliation of soft tissue and periosteum and requires that the distance between double incisions should be more than 7 cm which leads to more serious injury of soft tissue and increases the risk of infection and skin necrosis. Both tibia and fibula fixation can be taken into account in the same incision to reduce the secondary injury and blood circulation of soft tissue and to reduce postoperative complications. In this study, the clinical effect of single incision double plate internal fixation combined with early oral Xianfang Huoxing decoction in the treatment of distal tibia and fibula fracture was discussed, which provided a new choice for early treatment of distal tibia and fibula fracture. Methods: from June 2011 to April 2013, 21 patients with distal tibia and fibula fractures treated in Department of Orthopedics and Trauma, Wuhan traditional Chinese Medicine Hospital, were retrospectively analyzed, including 15 males and 6 females, with the minimum age of 28 years and the maximum age of 68 years. The causes of fracture were as follows: 13 cases of traffic accident injury, 5 cases of falling injury, 3 cases of compression injury, 11 cases of type A and 7 cases of type B and 3 cases of type C according to AO classification. The patients were divided into treatment group (n = 11) and control group (n = 10). All the patients were treated by the same group of doctors under continuous epidural anesthesia with a single incision on the anterolateral side of the leg. The fracture ends of the tibia and fibula were exposed and fixed with double plate after reduction. The control group was treated routinely after operation. In the treatment group, in addition to routine treatment, Xianfang Huoxing decoction was taken orally. The degree of swelling and pain relief were compared between the two groups. Functional evaluation was carried out according to Johner-wruh evaluation standard after operation and curative effect was observed. Results: all patients were followed up for 9-12 months (mean 10.6 months). On the 3rd day after operation, there were significant statistical differences in the degree of swelling and pain between the two groups (p < 0.05). Nine months after operation, according to Johner-wruh evaluation criteria, 17 cases were excellent, 2 cases were good, 2 cases were fair, and 0 cases were poor. The excellent and good rate was 90.5%. Conclusion: single anterolateral incision can fix tibia and fibula simultaneously and can effectively reduce the incidence of infection and skin necrosis. Single incision double plate internal fixation is easy to operate when it is used, has less injury to soft tissue, less complications, fixed firmly and has definite curative effect, Xianfang Huoxing decoction can effectively relieve the swelling and pain of the affected limbs after operation, and alleviate the pain of the patients. It provides a new choice for perioperative management.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R687.3

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