| Objectives:1 To explore clinical traction effectiveness of the self-designed controllable and portable double-pins traction device on leg in the treatament of tibiofibular fractures.2 Designed the comfortable mat for lifting lower limb was used to elevation and detumescence.To evaluate clinical application value of the mat for lifting on efficacy of limb elevation and detumescence in preoperative treatment of tibiofibular fracture.3 To evaluate the traction effectiveness and clinical application value of the controllable and portable double-pins integrative traction device on leg.Methods:1 Our controllable and portable double-pin traction device on leg was designed to fiulfill the purposes of traction and address current problems in traction for tibiofibular fractures.The device is composed of double-hole connectors,nuts of various specification,traction pin sleeves,2 transfixion pins and 2 threaded rods for traction.The transfixion pins fixed at the conventional traction position.Two threaded rods for traction paralleled to the long axis of lower limb and located on both sides of the leg.Bone ends can be distracted by adjusting the nut of M8 width and the speed of pulling can be controlled.The device can be used not only for rapid traction during surgery but also for slow traction preoperatively.From January 2017 to June 2018,60 patients with who had been treated at Department of Orthopaedic Surgery,920th Hospital of Joint Logistic Support Force(the former Kunming General Hospital of Chengdu Military Command).Patients were divided into A group(skeletal traction of the controllable and portable double-pin traction device on leg)and B group(the traditional single-pin calcaneal traction)according to random number table method,with 30 cases in each group.A group was given bone traction with the controllable and portable double-pins traction de-vice on leg,B group was given traditional single-pin calcaneal traction.For A group 30 patients,the radiographs were taken before traction and at 3 and 6 days after traction to observe the changes in overlapped fracture ends and fracture gap.The length of distraction were measured.After limited open reduction,fracture gaps and tension of surrounding soft-tissue were observed.During traction using the Visual Analogue Scale(VAS)standard assess Patient's pain after the 1st,3rd,6th 3rd?6th day of traction were recorded and compared between with two groups using the independent sample t test.The operative time,amount of intraoperative blood loss was compared between two groups using the independent sample t test.2 According to ergonomics and clinical application designed the comfortable mat for lifting lower limb.From September 2016 to October 2017,90 patients with tibiofibular fractures who were needed to treat with hospitalized by the Institute of trauma department of orthopedics in The Joint Service Support Force 920th Hospital of Chinese PLA(the former Kunming General Hospital of Chengdu Military Command).Patients were randomly divided into A group(the comfortable mat for lifting lower limb)and B group(the Bohler-Braun Frame),with 45 cases in each group.A group was given the comfortable mat for lifting lower limb to elevation and detumescence,B group was given the Bohler-Braun Frame to elevation and detumescence.The VAS score,comfortable degree and the difference limb circumference(the circumference of the swelling part of the fracture limb subtracting the circumference of the corresponding part of the healthy side)after the first day,3rd,6th day in hospitalization were recorded and compared between with two groups using the independent sample t test.3 From January 2017 to December 2018,30 patients with who had been treated at Department of Orthopaedie Surgery,920th Hospital of Joint Logistie Support Force.All patients were treated with the controllable and portable double-pin traction device on leg for skeletal traction before operation.The two pins traction position was tibial tuberosity traction and calcaneus traction.Patients were divided into A group(the controllable and portable double-pins integrative traction device on leg)and B group(the controllable and portable double,pins traction device on leg and the Bohler-Braun Frame)according to random number table method,with 15 cases in each group.Patients' fracture limb were placed on the comfortable mat for lifting lower limb to elevation and detumescence in A group,as observation group.Patients'fracture limb were placed on on the B6hler-Braun Frame to elevation and detumescence in B group,as the control group.During traction using the difference limb circumference(the circumference of the swelling part of the fracture limb subtracting the circumference of the corresponding part of the healthy side)and Immobilization Comfort Questionnaire(ICQ)assess effective detumescence and comfortable degree after the 1st,3rd,6th day of traction were recorded and eompared between with two groups using the independent sample t test.Results:1 Thirty patients' radiographs before and after traction demonstrated that their overlapped and displaced fracture ends were distracted more or less in skeletal traction of the controllable and portable double-pins traction device on leg group.The length of distraction ranged from 7.2mm to 45.8mm(mean,23.1mm),it was<15.0mm 6 cases(6/30,20.0%),between 15mm and 30mm 18 cases(18/30,60.0%),between 31mm and 45 mm in 5 cases(5/30,16.7%),and>45mm in one case(1/30,3.3%).Their radiographs showed that regular traction for 6 days was more obvious than that for 3 days.The limited open reduction revealed that the gap between fracture end was expanded,the soft-tissue tension effectively relaxed,the overlapping of fracture ends diminished,and the dissection of surrounding soft-tissue and periosteum decreased,leading to less difficulty in reduction.In the proximal joint or the fracture involving the articular surface,the joint space was enlarged.At the 3rd%6th day of traction,the VAS score in A group(skeletal traction of the controllable and portable double-pins traction device on leg)was lower than B group(the traditional single-pin calcaneal traction)[(4.13±0.97)score vs.(4.87±1.01)score,P=0.006,(2.40±0.97)score and vs.(3.13±1.07)score,P=0.004],the difference was statistically significant.It indicates that the controllable and portable double-pins traction device on leg has a sustained and effective traction effect,which is beneficial to soft tissue swelling and can alleviate patient's pain.The traction effect of the controllable and portable double-pins traction device on leg is superior to the traditional single-pin calcaneal traction.The operation time of A group was shorter than B group[(58.00±27.50)min vs.(72.67±17.11)min,P=0.016].The amount of intraoperative blood loss of A group was lower than B group[(114.83±38.98)ml vs.(171.83±45.65)ml,P<0.001],the difference was statistically significant.It shows that the controllable and portable double-pins traction device on leg can achieve effective traction,reduce intraoperative reduction intensity and amount of intraoperative blood loss in preoperative skeletal traction treatment.2 At the 6th day of admission,the VAS score in A group(the comfortable mat for lifting lower limb)was lower than B group(the B6hler-Braun Frame)[(2.67±0.80)score vs.(3.22±0.93)score,P=0.003],indicating that the comfortable mat for lifting lower limb alleviate pain was better than the Bohler-Braun Frame.The comfortable degree scores of A group was higher than B group at 3rd day[(23.62±3.00)score vs.(22.29±3.38)score,P=0.034]and 6th day[(25.82±1.56)score vs.(24.96±1.64)score,P=0.012].It suggested that comfortable mat can raise patient's comfortable dergree than the Bohler-Braun Frame.The difference limb circumference of A group was lower than B group at the 3rd[(3.27±0.70)cm vs.(3.60±0.78)cm,P=0.038]and the 6th day[(1.75±0.39)cm vs.(1.99±0.54)cm,P=0.022].It indicated that the detumescence effect of the comfortable mat for lifting lower limb was more effective than the Bohler-Braun Frane.3 In A group(the controllable and portable double-pins integrative traction device on leg)and B group(the controllable and portable double-pins traction device on leg and the Bohler-Braun Frame),there were no significant difference in the limb difference circumference between the 1st?3rd?6th day of traction.However,the limb difference circumference in A group(5.05±1.47)cm and(2.21±0.73)cm was lower than B group(4.55±1.44)cm and(2.29±0.72)cm at the 3rd?6th day of traction.It can be considered that the comfortable mat for lifting lower is similar to the Bohler-Braun Frame about effective limb elevation and detumescence in the preoperative traction treatment of high-energy distal tibiofibular fracture by the controllable and portable double-pins traction device on leg.The controllable and portable double-pins integrative traction device on leg has an effective limb elevation and detumescence effect.ICQ score of A group was higher than B group at 3rd day after traction[(82.800±5.62)score vs.(75.400±4.40)score,P=0.049]and 6th day[(78.73±5.18)score vs.(69.80±6.24)score,P=0.008],the differences were statistically significant.The study indicates that the controllable and portable double-pins integrative traction device on leg can significantly improve patient's comfortable dergree in the preoperative traction treatment.Conclusions:1 The self-designed controllable and portable double-pin traction device on leg is effective and advantageous traction effectiveness,because it is simple,easy,light in weight,and controllable for traction speed.Its application can alleviate patient's pain,improve patient's comfort,reduce intraoperative reduction intensity and amount of intraoperative blood loss.2 In the treatment of tibiofibular fracture elevation and detumescence,the comfortable mat for lifting lower limb can effective detumescence,alleviate pain and improve the patient's comfortable degree,it has good clinical application value.3 The controllable and portable double-pins integrative traction device on leg is a reliably effective traction device,which has the clinical application value of sustained and effective traction effectiveness,effective detumescence,improving the patient's comfortable degree. |
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