【摘要】：目的：脛腓骨遠(yuǎn)端骨折是臨床上較常見的骨折之一，當(dāng)腓骨也需要嚴(yán)格固定時，在切開復(fù)位內(nèi)固定治療中多采用雙切口，但是存在諸多問題，雙切口往往會造成軟組織及骨膜的過度剝離，且要求雙切口之間的距離應(yīng)大于7cm，這樣導(dǎo)致軟組織的更嚴(yán)重?fù)p傷，增加了感染及皮膚壞死的風(fēng)險。同一切口可同時兼顧脛骨和腓骨的固定，減輕對軟組織二次創(chuàng)傷及血運的破壞，減少術(shù)后并發(fā)癥的發(fā)生。本研究通過探討采用單一切口雙鋼板內(nèi)固定術(shù)配合術(shù)后早期口服仙方活命飲在脛腓骨遠(yuǎn)端骨折治療中的臨床療效，為脛腓骨遠(yuǎn)端骨折的早期處理提供一個新的選擇。方法：回顧性分析2011年6月至2013年4月武漢市中醫(yī)醫(yī)院骨傷科收治的脛腓骨遠(yuǎn)端骨折患者21例，男15例，女6例，最小年齡28歲，最大年齡68歲。骨折原因:車禍傷13例，跌落傷5例，壓傷3例。AO分型:A型11例，B型7例，C型3例。按術(shù)后是否使用口服中藥分為治療組（11例）和對照組（10例）。所有患者均由同一組醫(yī)生在連續(xù)硬膜外麻醉下采用小腿前外側(cè)單一切口切開，分別暴露出脛腓骨的骨折斷端，復(fù)位后予以雙鋼板固定，，對照組術(shù)后予常規(guī)處理，治療組術(shù)后除常規(guī)處理外加仙方活命飲內(nèi)服。比較兩組患者術(shù)后腫脹及疼痛緩解程度。并于術(shù)后按Johner-wruh評價標(biāo)準(zhǔn)進(jìn)行功能評價，觀察療效。結(jié)果：所有患者術(shù)后均獲得隨訪，隨訪9-12個月，平均10.6個月。術(shù)后第3、7天，對比患者腫脹、疼痛程度，均有顯著的統(tǒng)計學(xué)差異（p＜0.05）。術(shù)后九個月，按Johner-wruh評價標(biāo)準(zhǔn)進(jìn)行功能評價,優(yōu)17例，良2例，中2例，差0例，優(yōu)良率達(dá)90.5%。 結(jié)論：前外側(cè)單一切口可同時進(jìn)行脛骨和腓骨的固定，能有效降低感染及皮膚壞死的發(fā)生率。單一切口雙鋼板內(nèi)固定術(shù)在應(yīng)用時操作簡便，對軟組織損傷較小，并發(fā)癥少，固定牢靠，療效確切；仙方活命飲可以有效的緩解術(shù)后患肢腫痛，減輕患者的痛苦，為圍手術(shù)期的處理提供了一種新的選擇。
[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.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R687.3

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