组织工程与重建外科杂志

组织工程与重建外科杂志 ›› 2024, Vol. 20 ›› Issue (1): 87-.

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显微外科技术联合组合式外固定架在胫腓骨远端骨折伴严重软组织损伤中的应用

  

  • 发布日期:2024-03-07

 Application of microsurgical technique plus combined external fixator in distal tibia-fibula fractures with severe soft tissue injury

  • Published:2024-03-07

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摘要：

　目的　探索显微外科技术联合组合式外固定架在胫腓骨远端骨折伴严重软组织损伤中的应用效果。方法
选取2021年1月至2022年6月收治的84例胫腓骨远端骨折伴严重软组织损伤患者，根据治疗术式不同分为两组，采取
弹性髓内钉固定治疗的41例为对照组，采取显微外科技术联合组合式外固定架治疗的43例为观察组。观察两组手术
相关情况、术后疗效、术后并发症及不同时间点 X 射线骨痂评分、血清指标（BMP-2、VEGF、TGF-β），以及踝关节功能
（AOFAS）评分、Molander踝关节骨折评分系统（OMAS）评分。结果　观察组术前准备、手术操作、住院、完全负重、创面
愈合及骨折愈合时间均短于对照组，创面换药次数少于对照组（P＜0.05）；观察组术后1、
3个月X射线骨痂评分高于对
照组（P＜0.05）；观察组术后 1、
3个月血清 BMP-2、VEGF、TGF-β水平高于对照组（P＜0.05）；术后 3个月观察组手术优
良率及AOFAS、OMAS评分均高于对照组，术后并发症发生率低于对照组（P＜0.05）。结论　显微外科技术联合组合式
外固定架方案治疗胫腓骨远端骨折伴严重软组织损伤能有效固定骨折，较好保护与促进软组织修复，有利于促进骨折
愈合与早期肢体功能恢复，且能降低并发症发生风险。

关键词:

Abstract:

Objective To explore the application effect of microsurgical technique plus combined external fixator in the
treatment of distal tibia-fibula fracture with severe soft tissue injury. Methods A total of 84 patients with distal tibia-fibula
fracture with severe soft tissue injury from January 2021 to June 2022 were selected and divided into two groups according to
different treatment methods：41 patients treated with elastic intramedullary nail were included in the control group， and 43
patients treated with microsurgical technique combined with external fixators were included in the observation group. The
operation related situation， postoperative efficacy， postoperative complications， X-ray callus score， serum indexes （BMP-
2， VEGF， TGF-β）， ankle function （AOFAS） score， Molander ankle fracture scoring system （OMAS） score were compared
between the two groups. Results The time of preoperative preparation， operation， hospitalization， complete weight
bearing， wound healing and fracture healing in the observation group were shorter than those in the control group， and the
times of wound dressing changes were less than those in the control group （P<0.05）. The X-ray callus score of the observationgroup was higher than that of the control group at 1 and 3 months after surgery （P<0.05）
. The levels of serum BMP-2， VEGF and TGF-β in the observation group were higher than those in the control group at 1 month and 3 months after surgery （P<0.05）. Three months after operation， the good and excellent rate of operation， AOFAS and OMAS scores in observation group were higher than those in control group， and the incidence of postoperative complications was lower than that in the control group （P<0.05）. Conclusion Microsurgical technique plus combined external fixator in the treatment of distal tibia-fibula fracture with severe soft tissue injury can effectively fix the fracture， better protect and promote soft tissue repair， promote fracture healing and early limb functional recovery， and reduce the risk of complications.

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