The therapeutic method and effect of combining tibiofibular anterolateral approach with external fixation on the gustilo III distal tibiofibular fractures
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摘要:
目的观察经腓骨前方外侧入路结合外固定架治疗GustiloⅢ型胫腓骨远端骨折的临床疗效。 方法临床纳入GustiloⅢ型胫腓骨远端骨折患者70例，根据手术方案的不同分为研究组与对照组。研究组进行经腓骨前方外侧入路结合外固定架，对照组进行切开复位内固定。观察两组患者一般手术情况（手术时间、术中出血量、切口并发症等）。采用踝关节功能AOFAS评分对手术前后患者疗效进行评估。 结果研究组手术时间、术中出血量均少于对照组，差异有显著性（P<0.05）；研究组切口并发症发生率低于对照组，差异有显著性（P<0.05）；AOFAS评分方面，研究组疼痛、功能、对线、总分均高于对照组，差异有显著性（P<0.05）。 结论经腓骨前方外侧入路结合外固定架治疗GustiloⅢ型胫腓骨远端骨折的临床疗效优于切开复位内固定，能够减轻对患者的创伤，且并发症发生率较低，值得推广。 Abstract:Objective To study the clinical efficacy of combining tibiofibular anterolateral approach with external fixation on the Gustilo III distal tibiofibular fractures. Method 70 patients with Gustilo III distal tibiofibular fractures were selected and divided into the research group and the control group according to the operative plans. The research group were treated with tibiofibular anterolateral approach combined with external fixation while the control group were treated with open reduction combined with internal fixation. The general operation conditions (time of operation, intraoperative quantity of bleeding, incision complication, etc) of two groups were observed. According to the scores of AOFAS, the therapeutic effect were evaluated before and after surgery. Result The operation time and intraoperative quantity of bleeding of the research group were respectively（72.3 ± 9.6）min and（81.3 ± 9.5）ml while the operation time and intraoperative quantity of bleeding of the control group were respectively（86.3±10.3）min and（103.3±11.9）ml (P<0.05);The incidence rate of incision complication of the research group (2.86%) was significantly lower than that of the control group (17.14%) (P#60;0.05). According to AOFAS, the scores of ache, function and alignment as well as total points of the research group were respectively（34.5±7.5）,（42.7±3.2）,（9.5± 1.9）and（86.3±9.6）while the scores of ache, function and alignment as well as total points of the control group were respectively （31.6 ± 5.7）,（32.3 ± 7.0）,（8.2 ± 2.2）and（72.5 ± 13.7）.（P<0.05）. Conclusion The clinical efficacy of applying the tibiofibular anterolateral approach with external fixation to treat Gustilo III distal tibiofibular fractures is better than that of the treatment with open reduction combined with internal fixation, which could relieve the trauma for the patients and reduce the incidence rate of complication. It is worthy of promotion. -
表 1 两组患者一般手术情况比较（n=35）
组别 手术时间（min） 术中出血量（ml） 切口并发症（%） 研究组 72.3±9.6 81.3±9.5 1（2.86） 对照组 86.3±10.3 103.3±11.9 6（17.14） t/χ2 5.88 8.55 3.97 P <0.05 <0.05 <0.05 
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表 2 两组患者治疗前后AOFAS评分比较（n=35）
组别 疼痛 功能 对线 总分 手术前 手术后 手术前 手术后 手术前 手术后 手术前 手术后 研究组 20.3±4.0 34.5±7.5 15.3±1.3 42.7±3.2 3.6±0.7 9.5±1.9 42.3±5.5 86.3±9.6 对照组 19.7±4.3 31.6±5.7 15.7±1.5 32.3±7.0 3.8±0.6 8.2±2.2 41.9±5.7 72.5±13.7 t 0.6 1.82 1.19 7.99 1.28 2.65 0.3 4.88 P >0.05 <0.05 >0.05 <0.05 >0.05 <0.05 >0.05 <0.05
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