|
|
Clinical research on the ultimate treatment of adult tibial shaft closed fracture with external fixator |
WANG Chuanjin1,2, LI Peng1, YANG Shuye1, ZHANG Kai1* |
1 Department of Orthopedic Trauma, Binzhou Medical University Hospital, Binzhou 256603, Shandong,P. R. China; 2 Dongying Tongan Thoracic Surgery Hospital |
|
|
Abstract Objective To investigate the clinical effect of external fixator in the treatment of adult tibial shaft closed fracture. Methods Forty-seven adult patients with tibial shaft closed fracture were treated with external fixator. An external fixation framework was designed according to the type of fracture before surgery, and an external fixation frame was installed after the intraoperative X-ray fluoroscopy machine confirmed the closed reduction fracture was satisfactory. Nursing of nail track was strengthened after operation to prevent infection and all patients were followed up at regular intervals. According to the condition of bone healing mineralization shown in X-ray films, components of the frame were gradually dismantled to total remove of the frame in regular intervals. Results Forty-seven patients were followed up 12 to 36 months, with an average of (19.96±1.42) months. Forty-five cases of 47 patients healed normally and 2 patients had nonunion, with the healing rate 95.74%. The fracture healing time was from 4 to 14 months, with an average of (5.63±0.78) months. One case of nonunion healed smoothly after replacing plate and bone grafting, and the other one healed smoothly after Bone transport technique with ring external fixator. Three patients with mild pin-tract infection were cured after debridement and changing dressing associated with antibiotics. There were no impacts on the knee and ankle function in all patients. Conclusion External fixator is the ultimate treatment for closed fracture of tibial shaft in adults with satisfactory clinical efficacy. The appropriate external fixator can provide stable and reliable fixation strength for fracture healing, and can adjust the fixation strength according to the bone healing situation to improve stress shielding and avoid secondary surgical treatment, which has certain clinical application value.
|
Received: 31 October 2019
|
|
|
|
|
[1] HUSSEIN T, ARMAN M, ALEX T, et al. Closed fractures of the tibial shaft in adults[J]. Orthopaedics and Trauma, 2017, 31(2):116-124. [2] 徐佳明,艾自胜,张长青.胫腓骨骨折固定物与固定方式的研究进展[J].中国组织工程研究,2013,17(4):663-671. [3] 张宁宁,万春友,张涛,等.Taylor空间支架治疗胫腓骨中下段骨折疗效观察[J].中国修复重建外科杂志,2018,32(8):1012-1017. [4] MAY J D, PAAVANA T, MCGREGOR-RILEY J, et al. Closed Tibial shaft fractures treated with the Ilizarov method: A ten year case series[J].Injury, 2017,48(7):1613-1615. [5] AXELRAD T W,KAKAR S,EINHORN T A. New technologies for the enhancement of skeletal repair[J]. Injury, 2007,38(Suppl 1):49-62. [6] 秦泗河.下肢畸形与残缺外科治疗新技术新观念概论[J]. 中国矫形外科杂志,2011, 19(7): 599-602. [7] 李汉云, 钟世镇.胫骨血液供应的实验和解剖学研究[J].第一军医大学学报, 1986, 6 (2) :138-140. [8] 常文利,张英泽,陈伟.胫骨中下段骨折不愈合原因的研究进展[J].中国骨与关节杂志,2017,6(9):713-716. [9] 姚国仕,李冀,张丽.胫骨骨折的手术治疗进展[J].华北煤炭医学院学报,2011,13(2):185-187. [10] 郭庆山.关注细节,提高胫骨干骨折救治质量[J].创伤外科杂志,2018,20(5):321-323. [11] 徐佳明,艾自胜,张长青.胫腓骨骨折固定物与固定方式的研究进展[J].中国组织工程研究,2013,17(4):663-671. [12] BUSSE J W, MORTON E, LACCHETTI C, et al. Current management of tibial shaft fractures: A survey of 450 Canadian orthopedic trauma surgeons[J]. Acta Orthop, 2008,79:689-694. [13] MADADI F, EAJAZI A, MADADI F, et al. Adult tibial shaft fractures-different patterns, various treatments and complications[J]. Med Sci Monit, 2011,17(11):CR640-645. [14] GUBIN A V, BORZUNOV D Y, MALKOVA TA. The Ilizarov paradigm: thirty years with the Ilizarov method, current concerns and future research[J]. Int Orthop, 2013,37(8):1533-1539. [15] 张功林,葛宝丰.外固定支架治疗骨折研究进展[J].国际骨科学杂志,2011,32(2):99-101. [16] 张锴.Ilizarov外固定技术治疗小腿骨折[J].山东医药,2016,56(22):110-112. [17]王美,赵文,申庆民,等.骨外固定支架的临床应用进展[J].局解手术学杂志,2016,25(11):851-853. [18] 李朋,杜刚强,张锴,等.Ilizarov技术治疗胫骨创伤性骨髓炎的临床研究[J].中国矫形外科杂志,2014,22(12):1133-1137. [19] JACK M C, NEWMAN M I, BARNAVON Y. Islanded posterior tibial artery perforator flap for lower limb reconstruction: review of lower leg anatomy[J]. Plast Reconstr Surg, 2011, 127(2):1014-1015. |
[1] |
WANG Qinghua, WANG Feng, PANG Zehui, CHEN Qiangpu, CHENG Yu, QU Guiwu, GUAN Qinghai. Effect of ecological immune enteral nutrition support on prognosis and liver function of patients with severe acute pancreatitis[J]. 滨州医学院学报, 2019, 42(4): 257-259. |
[2] |
. [J]. 滨州医学院学报, 2019, 42(2): 144-145. |
[3] |
. [J]. 滨州医学院学报, 2019, 42(1): 60-61. |
[4] |
LIU Yong, LI Jianmin. Clinical study of LVIS stent in the treatment of intracranial aneurysms[J]. 滨州医学院学报, 2018, 41(3): 165-167. |
[5] |
XU Jing, GE Ruli, HOU Yiwei. Effect of mNGF in the treatment and levels of serum MBP,NSE,and VEGF in patients with cerebral infarction[J]. 滨州医学院学报, 2018, 41(3): 171-173. |
[6] |
. [J]. 滨州医学院学报, 2018, 41(3): 218-219. |
|
|
|
|