PDF(Pubmed)
Abstract：
BACKGROUND: It\'s difficult to treat segmental tibial fractures (STFs), which are intricate injuries associated with significant soft tissue damage. The aim of this study was to compare the clinical effect of hexaxial external fixator (HEF) and intramedullary nail (IMN) in treatment of STFs.
METHODS: A total of 42 patients with STFs were finally recruited between January 2018 and June 2022. There were 25 males and 17 females with age range of 20 to 60 years. All fractures were classified as type 42C2 using the Arbeitsgemeinschaftfür Osteosythese/Orthopaedic Trauma Association (AO/OTA) classification. 22 patients were treated with HEF and 20 patients were treated with IMN. The condition of vascular and neural injuries, time of full weight bearing, bone union time and infection rate were documented and analyzed between the two groups. The mechanical medial proximal tibial angle (mMPTA), mechanical posterior proximal tibial angle (mPPTA), mechanical lateral distal tibial angle (mLDTA), mechanical anterior distal tibial angle (mADTA), hospital for special surgery (HSS) knee joint score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle joint score, range of motion (ROM) of flexion of keen joint and ROM of plantar flexion and dorsal flexion of ankle joint were compared between the two groups at the last clinical visit.
RESULTS: There were no vascular and neural injuries or other severe complications in both groups. All 22 patients in HEF group underwent closed reduction but 3 patients in IMN group were treated by open reduction. The time of full weight bearing was (11.3 ± 3.2) days in HEF group and (67.8 ± 5.8) days in IMN group(P < 0.05), with bone union time for (6.9 ± 0.8) months and (7.7 ± 1.4) months, respectively(P < 0.05). There was no deep infection in both groups. In the HEF group and IMN group, mMPTA was (86.9 ± 1.5)° and (89.7 ± 1.8)°(P < 0.05), mPPTA was (80.8 ± 1.9)° and (78.6 ± 2.0)°(P < 0.05), mLDTA was (88.5 ± 1.7)° and (90.3 ± 1.7)°(P < 0.05), while mADTA was (80.8 ± 1.5)° and (78.4 ± 1.3)°(P < 0.05). No significant differences were found between the two groups at the last clinical visit concerning HSS knee joint score and AOFAS ankle joint score, ROM of flexion of keen joint and ROM of plantar flexion of ankle joint (P > 0.05). The ROM of dorsal flexion of ankle joint in IMN group was (30.4 ± 3.5)°, better than (21.6 ± 2.8)° in HEF group (P < 0.05).
CONCLUSIONS: In terms of final clinical outcomes, the use of either HEF or IMN for STFs can achieve good therapeutic effects. While HEF is superior to IMN in terms of completely closed reduction, early full weight bearing, early bone union and alignment. Nevertheless, HEF has a greater impact on the ROM of dorsal flexion of the ankle joint, and much more care and adjustment are needed for the patients than IMN.
METHODS: A total of 42 patients with STFs were finally recruited between January 2018 and June 2022. There were 25 males and 17 females with age range of 20 to 60 years. All fractures were classified as type 42C2 using the Arbeitsgemeinschaftfür Osteosythese/Orthopaedic Trauma Association (AO/OTA) classification. 22 patients were treated with HEF and 20 patients were treated with IMN. The condition of vascular and neural injuries, time of full weight bearing, bone union time and infection rate were documented and analyzed between the two groups. The mechanical medial proximal tibial angle (mMPTA), mechanical posterior proximal tibial angle (mPPTA), mechanical lateral distal tibial angle (mLDTA), mechanical anterior distal tibial angle (mADTA), hospital for special surgery (HSS) knee joint score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle joint score, range of motion (ROM) of flexion of keen joint and ROM of plantar flexion and dorsal flexion of ankle joint were compared between the two groups at the last clinical visit.
RESULTS: There were no vascular and neural injuries or other severe complications in both groups. All 22 patients in HEF group underwent closed reduction but 3 patients in IMN group were treated by open reduction. The time of full weight bearing was (11.3 ± 3.2) days in HEF group and (67.8 ± 5.8) days in IMN group(P < 0.05), with bone union time for (6.9 ± 0.8) months and (7.7 ± 1.4) months, respectively(P < 0.05). There was no deep infection in both groups. In the HEF group and IMN group, mMPTA was (86.9 ± 1.5)° and (89.7 ± 1.8)°(P < 0.05), mPPTA was (80.8 ± 1.9)° and (78.6 ± 2.0)°(P < 0.05), mLDTA was (88.5 ± 1.7)° and (90.3 ± 1.7)°(P < 0.05), while mADTA was (80.8 ± 1.5)° and (78.4 ± 1.3)°(P < 0.05). No significant differences were found between the two groups at the last clinical visit concerning HSS knee joint score and AOFAS ankle joint score, ROM of flexion of keen joint and ROM of plantar flexion of ankle joint (P > 0.05). The ROM of dorsal flexion of ankle joint in IMN group was (30.4 ± 3.5)°, better than (21.6 ± 2.8)° in HEF group (P < 0.05).
CONCLUSIONS: In terms of final clinical outcomes, the use of either HEF or IMN for STFs can achieve good therapeutic effects. While HEF is superior to IMN in terms of completely closed reduction, early full weight bearing, early bone union and alignment. Nevertheless, HEF has a greater impact on the ROM of dorsal flexion of the ankle joint, and much more care and adjustment are needed for the patients than IMN.
摘要：
背景：很难治疗胫骨节段性骨折（STFs），是与严重软组织损伤相关的复杂损伤。本研究的目的是比较六轴外固定器（HEF）和髓内钉（IMN）治疗STFs的临床效果。
方法：最终在2018年1月至2022年6月之间招募了42名STF患者。男性25例，女性17例，年龄在20至60岁之间。使用Arbeitsgemeinschaftfür骨修复/骨科创伤协会（AO/OTA）分类将所有骨折分类为42C2型。22例患者接受HEF治疗，20例患者接受IMN治疗。血管和神经损伤的状况，完全承重的时间，记录并分析两组的骨愈合时间和感染率。胫骨近端机械内侧角(mMPTA),胫骨近端后角（mPPTA），胫骨远端机械外侧角（mLDTA），机械胫骨远端前角（mADTA），特殊外科医院（HSS）膝关节评分，美国骨科足踝协会（AOFAS）踝关节评分，在最后一次临床就诊时，比较两组患者的敏锐关节屈曲活动度（ROM）和踝关节足底屈曲和背屈曲活动度。
结果：两组均无血管和神经损伤或其他严重并发症。HEF组22例患者均行闭合复位，IMN组3例患者行开放复位。HEF组完全负重时间为(11.3±3.2)天,IMN组为(67.8±5.8)天,差异有统计学意义(P<0.05)。骨愈合时间为（6.9±0.8）个月和（7.7±1.4）个月，分别为(P<0.05)。两组均无深部感染。在HEF组和IMN组中，mMPTA分别为(86.9±1.5)°和(89.7±1.8)°(P<0.05),mPPTA分别为(80.8±1.9)°和(78.6±2.0)°(P<0.05),mLDTA分别为(88.5±1.7)°和(90.3±1.7)°(P<0.05),mADTA分别为(80.8±1.5)°和(78.4±1.3)°(P<0.05)。两组末次临床就诊时HSS膝关节评分和AOFAS踝关节评分差异无统计学意义。踝关节屈曲ROM和踝关节足底屈曲ROM（P>0.05）。IMN组踝关节背屈ROM为(30.4±3.5)°,HEF组优于(21.6±2.8)°(P<0.05)。
结论：就最终临床结果而言，使用HEF或IMN治疗STFs均可取得良好的治疗效果。虽然HEF在完全封闭还原方面优于IMN，早期完全承重，早期骨愈合和对齐。然而，HEF对踝关节背屈ROM有较年夜影响，与IMN相比，患者需要更多的护理和调整。
方法：最终在2018年1月至2022年6月之间招募了42名STF患者。男性25例，女性17例，年龄在20至60岁之间。使用Arbeitsgemeinschaftfür骨修复/骨科创伤协会（AO/OTA）分类将所有骨折分类为42C2型。22例患者接受HEF治疗，20例患者接受IMN治疗。血管和神经损伤的状况，完全承重的时间，记录并分析两组的骨愈合时间和感染率。胫骨近端机械内侧角(mMPTA),胫骨近端后角（mPPTA），胫骨远端机械外侧角（mLDTA），机械胫骨远端前角（mADTA），特殊外科医院（HSS）膝关节评分，美国骨科足踝协会（AOFAS）踝关节评分，在最后一次临床就诊时，比较两组患者的敏锐关节屈曲活动度（ROM）和踝关节足底屈曲和背屈曲活动度。
结果：两组均无血管和神经损伤或其他严重并发症。HEF组22例患者均行闭合复位，IMN组3例患者行开放复位。HEF组完全负重时间为(11.3±3.2)天,IMN组为(67.8±5.8)天,差异有统计学意义(P<0.05)。骨愈合时间为（6.9±0.8）个月和（7.7±1.4）个月，分别为(P<0.05)。两组均无深部感染。在HEF组和IMN组中，mMPTA分别为(86.9±1.5)°和(89.7±1.8)°(P<0.05),mPPTA分别为(80.8±1.9)°和(78.6±2.0)°(P<0.05),mLDTA分别为(88.5±1.7)°和(90.3±1.7)°(P<0.05),mADTA分别为(80.8±1.5)°和(78.4±1.3)°(P<0.05)。两组末次临床就诊时HSS膝关节评分和AOFAS踝关节评分差异无统计学意义。踝关节屈曲ROM和踝关节足底屈曲ROM（P>0.05）。IMN组踝关节背屈ROM为(30.4±3.5)°,HEF组优于(21.6±2.8)°(P<0.05)。
结论：就最终临床结果而言，使用HEF或IMN治疗STFs均可取得良好的治疗效果。虽然HEF在完全封闭还原方面优于IMN，早期完全承重，早期骨愈合和对齐。然而，HEF对踝关节背屈ROM有较年夜影响，与IMN相比，患者需要更多的护理和调整。
