闭合复位髓内钉内固定治疗复杂胫骨骨折术中如何快速判断远端内外旋转  

Rapid judgment of distal inward or outward rotation during closed reduction and intramedullary nailing for complex tibial fractures

作　　者：马腾[1] 王谦[1] 路遥[1] 孙亮[1] 卢代刚[1] 李明[1] 薛汉中[1] 段宁[1] 张聪明[1] 李忠[1] 张堃[1] 

机构地区：[1]西安交通大学医学院附属红会医院创伤骨科,710054

出　　处：《中华创伤骨科杂志》2017年第10期874-879,共6页Chinese Journal of Orthopaedic Trauma

基　　金：陕西省社会发展科技攻关项目（2015SF116,2015SF110.2016SF340）

摘　　要：目的探讨复杂胫骨骨折闭合复位髓内钉内固定手术治疗过程中如何快速判断远端内外旋转、避免复位不良。方法回顾性分析2014年1月至2016年1月期间采用闭合复位髓内钉内固定治疗的21例复杂胫骨骨折患者资料。男16例，女5例；年龄22～53岁，平均34．6岁。骨折按AO／OTA分型：42-C1型6例，42-C2型2例，42-C3型13例。术中利用胫骨髓内钉前侧压杆连杆与第2跖骨的关系进行旋转判断。术后利用CT平扫判断该手术方法的可靠性。对比分析伤前与末次随访时患侧膝关节功能指数问卷（FIQ）评分、Olerud Molander踝关节评分系统（OMAS）及中文版健康状况问卷（SF-36）评分，再次验证利用胫骨髓内钉前侧压杆连杆作为测量杆术中判断远端旋转的可行性及可靠性。结果21例患者术后获12～24个月（平均18．3个月）随访。骨折端于术后3～7个月（平均4．5个月）获得骨性愈合，未出现骨不连、再骨折等并发症。术后CT平扫两侧胫骨近端和胫骨远端的切线角度差，健侧平均为47．1°±2．9°，患侧平均为44．8°±5．6°，差异无统计学意义（P〉0．05）。伤前与末次随访时患侧膝关节FIQ评分、踝关节OMAS评分及中文版SF-36评分比较差异均无统计学意义（P〉0．05）。结论复杂胫骨骨折闭合复位髓内钉内固定术中，利用胫骨髓内钉前侧压杆连杆作为测量杆，使其指向第2跖骨可以作为一种简单、有效的判断骨折远端是否发生内外旋转的方法。Objective To explore how to make a rapid judgment of distal inward or outward rotation during closed reduction and intramedullary nailing for complex tibial fractures so as to avoid bad reduction of the distal rotation. Methods Twenty-one patients with complex tibial fracture underwent closed reduction and intramedullary nailing from January 2014 to January 2016. They were 16 males and 5 females, aged from 22 to 53 years （average, 34.6 years）. By AO/OTA classification, 6 cases were type 42-C1, 2 type 42-C2, and 13 type 42-C3. During surgery, the relationship between the connecting rod of the front pressure lever of intramedullary nail in the tibia and the second metatarsal bone was used to judge the rotation. After surgery CT plane scanning was used to assess reliability of the intraoperative judgment of the rotation. Validity of the rotation judgment was finally evaluated by comparing Functional Index Questionnaire （FIQ） scores, Olerud Molander ankle scores （OMAS） and Health Status Questionnaire （SF-36） scores between pre-injury and final follow-up. Results The 21 patients were followed up for 12 to 24 months （average, 18.3 months）. Bony union was achieved from 3 to 7 months after surgery （average, 4.5 months） without nonunion or refracture. There was no significant difference in the tangent angle between the proximal and distal tibiae on CT scan between the healthy side （47.1 ~ ＋ 2.9~） and the affected side （44.8~ ~ 5.6~） （ P 〉 0.05）. There were no significant differences either in FIQ scores, OMAS or SF-36 scores between pre-injury and final follow-up （ P 〉 0.05 ）. Conclusion In the course of closed reduction and intramedullary nailing for complex tibial fractures, it is simple and effective to judge the distal inward or outward rotation by pointing the connecting rod of the front pressure lever of intramedullary nail in the tibia to the second metatarsal bone.

关 键 词：胫骨骨折 骨折固定术 髓内 可行性研究 判断 

分 类 号：R687.3[医药卫生—骨科学]