胫腓骨下段骨折内固定术后并拇趾屈曲和爪形趾畸形原因分析(附3例报告)  

Analysis of causes of toes deformity occured postoperatively in fractures of distal tibia and fibula-3 cases report

作　　者：汤世斌 骆志权 胡耀华 刘小明 

机构地区：[1]中山市南朗医院,广东中山528451

出　　处：《临床医药实践》2017年第10期788-791,共4页Proceeding of Clinical Medicine

摘　　要：目的:分析胫腓骨下段骨折内固定术后并发足趾畸形的原因以及后期矫形治疗效果。方法:2013年8月—2016年4月收治的3例胫腓骨下段骨折患者,采用钢板、螺钉内固定治疗,其中1例胫腓骨下段骨折采用胫骨下段外侧锁定钢板+腓骨下段解剖锁定钢板内固定,1例胫骨下段Pilon骨折和腓骨下段骨折采用胫骨下段内侧LISS锁定钢板+腓骨下段钢板+胫骨远端前后单枚松质骨拉力螺钉内固定,1例内外踝骨折伴下胫腓韧带断裂采用内踝两枚皮质骨螺钉+腓骨下段钢板+下胫腓韧带单枚皮质骨螺钉内固定。结果:术后第1天和第1个月分别出现患侧拇趾背伸乏力(其中2例发展为单一拇趾屈曲畸形,1例发展为累及第1至第4趾重型爪形趾畸形);切口感染2例。随访1~26个月,1例爪形趾畸形矫形后随访1年,末次随访未见畸形复发,Maryland足功能评分96分,评定为优。结论:胫腓骨下段骨折内固定术后并发拇趾屈曲畸形或爪形趾畸形的原因与损伤部位、局部解剖特点以及手术操作有关,与内固定方式无关;并发重型爪形趾畸形原因不能单用拇趾长屈肌腱粘连解释,似乎和腓深神经损伤有关(挫伤、术中牵拉伤),后期通过合适的矫形手术也可获得满意的临床效果。Objective： To investigate the causes of toe deformity occured postoperatively in fractures of distal tibia and fibula,and to share experiences on its managment. Methods： Three patients with fractures of distal tibia and fibula were treated by internal fixation with plates and screws from August 2013 to April 2016. 1 case with fractures of distal tibia and fibula were fixed by a lateral locking plate for lower tibial and an anatomical locking plate for lower fibula,1 case with fractures of‘Pilon＇of distal tibia and lower fibula were fixed by a medial plate（ LISS） for lower tibia,a locking plate for lower fibula and a single cancellous lag screw（ anteroposterior position）,respectivtly. And another one case with fractures of internal and external malleolus accompanied by rupture of inferior tibiofibular ligament were fixed by two cortical screws for internal malleolus,a locking plate for lower fibula and a single cortical screw,respectively. Results： All cases were followed-up for 10 months on average（ range： 1 ~ 26 months）. Hallux flexion deformity occuered after internal fixation in 2 cases（ occured in 1 day and 1month after surgery respectively,out of contact in 1month and 3 months after surgery respectively）,and claw toes deformity in 1case（ occured in 1 day after surgery）,infections of incition in 2 cases. Corrective surgery was received for one case of claw toes deformity 14 months after the first surgery,and followed-up for 1 year. At the last follow up,according to Maryland criteria,the foot function score was 96,and functional assesment was excellent. Conclusion： Causes of hallux flexion and claw toes deformity occuered after internal fixation were associated with injury sites,features of the local anatomy and procedures of surgery,and have nothing to do with internal fixation mode. The causes of severe toes deformity cannot be interpreted only by adehsion of tendons,it may be associated with the deep peroneal nerve injuries（ bruises or traction injury）,good results cou

关 键 词：胫腓骨下段骨折 术后 足趾畸形 原因分析 

分 类 号：R681.8[医药卫生—骨科学]