肱骨近端解剖接骨板治疗骨质疏松型后踝骨折  

Osteoporotic fractures of posterior malleolus fixed with proximal humerus plate

作　　者：曹贞国[1] 周星娟[2] 魏东[1] 岳喜军[1] 

机构地区：[1]徐州医学院附属第二医院骨科,江苏徐州221006 [2]徐州医学院解剖学教研室

出　　处：《骨科》2015年第3期122-126,共5页ORTHOPAEDICS

摘　　要：目的探讨肱骨近端解剖接骨板（anatomy of the proximal humerus plate,APHP）治疗骨质疏松型后踝骨折的临床疗效。方法选取我院2010年1月至2013年1月的18例骨质疏松型后踝骨折患者（其中1例为螺钉内固定失败患者行二次固定）,采用小腿后内侧入路,应用肱骨近端接骨板内固定治疗,术后石膏固定4周,早期分阶段行功能康复锻炼。根据美国矫形足踝协会（AOFAS）踝与后足评分标准评估治疗效果。结果伤口均一期愈合,无伤口感染、皮肤坏死等严重并发症,随访时间为12～24个月,平均16个月。X线检查示骨折于术后6.0～16.0个月愈合,平均9.2个月;根据AOFAS踝与后足评分标准进行功能评估：优12例,良5例,中1例,优良率为94.4%。结论肱骨近端接骨板符合胫骨远端后外侧的解剖形态,接骨板与后踝贴合良好,覆盖面积大,通过加压,使得接骨板的作用力较均匀地分散在后踝骨折块上,避免了拉力螺钉内陷、松动等并发症,效果良好。Objective To investigate the clinical efficacy of the anatomy of the proximal humerus plate （APHP） for osteoporotic fractures of posterior malleolus. Methods Eighteen cases of fresh closed and osteoporotic fractures of posterior malleolus were selected from Jan. 2010 to Jan. 2013 （one patient received secondary fixation with proximal humerus plate due to failure of the screw internal fixation）. All the patients received the treatment of APHP through the posteromedial approach, and solid internal fixation was acquired with piaster fixed for 4 weeks, while the postoperative rehabilitation exercises were strictly performed. The functional assessments were done according to American Orthopaedic Foot and Ankle Society （AOFAS） malleolus and hindfoot scores. Results Eighteen cases were followed up for 12-24 months （16 months on average）, and the fractures were healed without infection, skin necrosis or other serious complications. X-ray examination revealed that the fracture was healed after 6. 0-16. 0 months （9. 2 months on average） ; The functional assessments by AOFAS malleolus and hindfoot scores were excellent in 12 cases, good in 5 cases, and fair in 1 case with an excellent and good rate of 94. 4%. Conclusion The APHP meets the anatomic morphology of the distal medial tibia, and the posterior malleolus is fitted well with the plate, with larger coverage area. By pressure, the forces of proximal humerus plate are more evenly dispersed on the fragments of posterior malleolus fracture, avoiding complications such as retraction and loosening of the lag screw.

关 键 词：后踝骨折 骨折固定术 内 内固定器 骨质疏松 

分 类 号：R687.3[医药卫生—骨科学]