| Objective:In order to compare the biomechanical and the treatment efficacy results of external locking plate and external fixator for fixing middle or distal tibial fracture,and explore risk factors for infection after operation of open tibal fractures.Methods:1.Eighty sets of bovine tibial bones were selected and randomly divided into four groups(n=20):Al,A2,B1 and B2 group.The specimens in A1 and A2 groups were made into artificial middle tibial fracture models and adopted the fixation of the extermal locking plate in A1 and the fixation of the external fixator in A2,the bones in BI and B2 groups were made into artificial diatal tibial fracture models and adopted the fixation of the external locking plate in B1 and the fixation of the external fixator in B2.2.64 patients with open tibial fractures were selected from 2014 to 2016.The observation group had 16 cases were treated with locking plate external,and the control group had 48 cases were treated with external fixator.The time needed for fracture healing,the incidence of postoperative complications and the therapeutic effects after operation in three months were compared between the two groups.3.A total of 143 patient with unilateral open tibial fracture were retrospectively analyzed in 2016.Statistics the data with age,gender,smoking history,basic diseases(diabetes history,epilepsy,hypertension,HBV-infection),fracture location,frature location,fracture classification frade(Gostilo-classification),duration of surgery(if or not(?)150min),initial debridement time((if or not(?)6h),frature graft(skin transfer)and bone grafe.To analsis the risk factors related to postoperative infection with the logisticre gression.Bacterial culture were performed for cases with infection.Results:1.Under the different axial compressive loads,the axial displacements in A2(B2)group were greater than those in A1(B1)group,and the difference between 2 groups were significant(P<0.05).Under the different torsional loads,the torsion angles in A1(B1)group were not significantly different from those in A2(B2)group(P>O.05).2.The healing time of the observation group was 12.4±4.3 weeks,which was shorter than 22.1±5.6 weeks of the control group,the difference was statistically significant(P<0.05).The incidence of postoperative complications in the observation group was 25%(P<0.05),which was lower than 43.75%in the control group,the difference was statistically significant(P<0.05).The excellent rate of the observation group after 3 months was 93.8,which was higher than 85.42%in the control group.3.The result of multi-Logistic regression analysis showed that the risk factors for postoperative infection of open tibia fracture included fracture classification(P =0.000),diabetes history(P = 0.031)and initial debridement time(P = 0.000)were statistically significant.And other factors were not statistically significant.Conclusion:1.Using the LCP as an external fixator may become a new and more advantageous treatment method for open tibiai fracture since the fixation of middle or distal tibial fracture by external locking plate can prvide the same rotation stability as the fixation by extermal fixator does,but better axial stability.2.Compared with extemalfixator fixation,surgical treatment of tibial fracture is better than external fixator,it can shorten the treatment time,reduce the economic burden and reduce the incidence of postoperative complications.3.The risk factors for postoperative infection of open fracture of tibia include fracture classification,diabetes history and initial debridement time.Although epilepsy history and duration of surgery were not statistically significant,but showing a certain trend. |
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