CAJ | 학술논문

目的探讨高能量损伤导致的严重胫骨平台骨折分阶段治疗中,跨关节临时外固定支架固定是否增加最终内固定术前下肢深静脉血栓形成(DVT)的发生率. 方法对2010年1月至2011年12月收治的55例高能量损伤导致的AO分型C型的胫骨平台骨折患者进行回顾性研究,按照行最终内固定前采用的临时治疗方法不同分为外固定组(急诊跨关节临时外固定支架固定)和对照组(长腿后托石膏制动),其中外固定组22例,男16例,女6例,平均44.2岁；对照组33例,男26例,女7例,平均42.2岁.所有患者于行最终内固定术前做下肢彩色多普勒超声检查,对于可疑患者则行下肢静脉造影,以确定是否发生DVT,比较两组患者行最终内固定术前DVT的发生率. 结果外固定组与对照组分别有7例(近端4例,远端3例)和9例(近端5例,远端4例)患者发生DVT,发生率分别为31.8％和27.3％,差异无统计学意义(x2=1.320,P=0.716).外固定组和对照组近端DVT发生率分别为18.2％和15.2％,差异无统计学意义(x2=0.886,P=0.766).两组均为无症状DVT,发生时间分别为受伤后(7.6±1.7)d和(5.2±2.8)d.结论高能量损伤导致的严重胫骨平台骨折的分阶段治疗过程中,与石膏制动相比,使用跨关节临时外固定支架固定不会增加最终内固定术前DVT的发生率.
목적 탐토고능량손상도치적엄중경골평태골절분계단치료중,과관절림시외고정지가고정시부증가최종내고정술전하지심정맥혈전형성(DVT)적발생솔. 방법 대2010년1월지2011년12월수치적55례고능량손상도치적AO분형C형적경골평태골절환자진행회고성연구,안조행최종내고정전채용적림시치료방법불동분위외고정조(급진과관절림시외고정지가고정)화대조조(장퇴후탁석고제동),기중외고정조22례,남16례,녀6례,평균44.2세；대조조33례,남26례,녀7례,평균42.2세.소유환자우행최종내고정술전주하지채색다보륵초성검사,대우가의환자칙행하지정맥조영,이학정시부발생DVT,비교량조환자행최종내고정술전DVT적발생솔. 결과외고정조여대조조분별유7례(근단4례,원단3례)화9례(근단5례,원단4례)환자발생DVT,발생솔분별위31.8％화27.3％,차이무통계학의의(x2=1.320,P=0.716).외고정조화대조조근단DVT발생솔분별위18.2％화15.2％,차이무통계학의의(x2=0.886,P=0.766).량조균위무증상DVT,발생시간분별위수상후(7.6±1.7)d화(5.2±2.8)d.결론 고능량손상도치적엄중경골평태골절적분계단치료과정중,여석고제동상비,사용과관절림시외고정지가고정불회증가최종내고정술전DVT적발생솔.
Objective To discuss whether the cross-joint external fixator increased the incidence of deep venous thromboembolism (DVT) in severe tibial plateau fractures caused by high energy injury.Methods We retrospectively studied 55 cases of severe tibial plateau fracture (AO type C) that had been treated in our hospital from January 2010 to December 2011.We divided them into 2 groups according to the temporary fixation.In study group,the emergency cross-joint external fixators were applied and in the control group plaster immobilization was applied.The study group had 16 males and 6 females with an average age of 44.2 years while the control group had 26 males and 7 females with an average age of 42.2 yeas.Color Doppler examination of the lower limb was conducted in all patients before definite internal fixation.Phlebography of the lower limb was performed in suspected DVT cases.Incidences of DVT in the 2 groups were compared before the definite internal fixation.Results Seven cases (4 proximal and 3 distal ones) in the study group and 9 cases (5 proximal and 4 distal ones) in the control group were found to develop DVT.There was no significant difference between the 2 groups in the DVT incidences (31.8％ vs.27.3％) (x2 =1.320,P =0.716).There was no significant difference between the 2 groups either in the proximal DVT incidences (18.2％ vs.15.2％) (x2=0.886,P=0.766).The DVT cases found in the 2 groups were all asymptomatic; the time of DVT onset was 7.6 ± 1.7 days after initial injury in the study group and 5.2 ± 2.8 days in the control group.Conclusion In the staged treatment of severe tibial plateau fractures,compared with plaster immobilization,the temporary cross-joint external fixator will not increase the incidence of DVT before the definite internal fixation.