两种内固定方法治疗胫骨下1/3螺旋形骨折伴Haraguchi Ⅱ型后踝骨折的比较  

Comparison of two types of internal fixation of spiral fracture in distal 1/3 tibia combined with Haraguchi type Ⅱ posterior malleolar fracture

作　　者：程邦君[1] 罗轶[1] 黄俊伍[1] 冯晓兵 CHENG Bangjun;LUO Yi;HUANG Junwu;FENG Xiaobing(Department of Orthopaedics,Jinshan Branch of Shanghai Sixth People’s Hospital,Shanghai 201599,China)

机构地区：[1]上海市第六人民医院金山分院骨科,201599

出　　处：《国际骨科学杂志》2018年第2期114-117,共4页International Journal of Orthopaedics

基　　金：上海市科学技术委员会科研计划项目(14411972600);上海市卫生和计划生育委员会研究课题(2013-319)

摘　　要：目的比较胫骨下1/3螺旋形骨折伴Haraguchi Ⅱ型后踝骨折两种内固定手术方式的疗效。方法手术治疗61例胫骨下1/3螺旋形骨折伴Haraguchi Ⅱ型后踝骨折患者。其中胫骨下1/3螺旋形骨折均采用钢板内固定治疗,Haraguchi Ⅱ型后踝骨折分别采用3枚空心螺钉内固定(34例)和"L"形钢板内固定(27例)。采用Baird-Jackson评定标准评价踝关节功能。结果 61例患者术后随访6~36个月,平均20.8个月。骨折均愈合良好,无骨折延迟愈合或不愈合。Baird-Jackson踝关节功能评定:空心螺钉组优18例,良10例,可5例,差1例,优良率82.4%;钢板组优14例,良9例,可3例,差1例,优良率85.2%;两组优良率差异无统计学意义(P>0.05)。结论手术治疗胫骨下1/3螺旋形骨折合并Haraguchi Ⅱ型后踝骨折时,采用空心螺钉或"L"形钢板治疗Haraguchi Ⅱ型后踝骨折在临床疗效上无明显差异,空心螺钉内固定损伤小,而钢板内固定牢固可靠。Objective To compare the clinical efficacy of two types of internal fixation of spiral fracture in distal 1/3 tibia combined with Haraguchi typeⅡposterior malleolar fracture.Methods A total of 61 patients suffering spiral fracture in distal 1/3 tibia combined with Haraguchi typeⅡposterior malleolar fracture were included.All the spiral tibial fractures were fixed with plates.The Haraguchi typeⅡposterior malleolus fractures were either fixed with 3 cannulated screws(34 cases)or an“L”type plate(27 cases).The postoperative function of the affected ankle joints was evaluated according to the Baird-Jackson scoring system.Results All patients were followed up for an average of 20.8±4.2 months(range,6-36 months).All fractures healed,and no delayed union or nonunion occurred.According to the Baird-Jackson scoring system:the ankle joint function of the cannulated screw group was excellent in 18 cases,good in 10 cases,fair in 5 cases and poor in 1 case,and the excellent and good rate was 82.4%;while the ankle joint function of the plate group was excellent in 8 cases,good in 9 cases,fair in 3 cases and poor in 1 case,and the excellent and good rate was 85.2%.No statistically significant difference was observed in terms of the excellent and good rate between the two groups(P>0.05).Conclusion There was no significant difference in terms of the clinical efficacy between the two types of internal fixation of Haraguchi typeⅡposterior malleolar fracture.The cannulated screw fixation cause less damage,while the“L”type plate fixation was more reliable.

关 键 词：胫骨 踝关节 骨折 内固定 

分 类 号：R687.3[医药卫生—骨科学]