桡骨远端T形钢板治疗垂直型内踝骨折18例  

Distal radius T-plate for 18 patients with vertical shear medial malleolus fractures

作　　者：郑旭欣 曹扬 郑艳峰 沈晓震 吴青华 ZHENG Xu-xin;CAO Yang;ZHENG Yan-feng;SHEN Xiao-zhen;WU Qing-hua(Department of Orthopaedics,Jinhua People's Hospital,Jinhua 321000,Zhejiang,China)

机构地区：[1]金华人民医院骨科,浙江金华321000

出　　处：《中国骨伤》2020年第3期265-268,共4页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨采用桡骨远端T形钢板治疗垂直型内踝骨折的临床疗效。方法 :回顾性分析2014年3月至2016年3月收治的18例垂直型内踝骨折患者的临床资料,其中男12例,女6例;年龄22~63 (41.3±5.2)岁;左侧6例,右侧12例;5例伴外踝骨折,13例伴外踝和后踝骨折。所有患者采用桡骨远端T形钢板固定治疗。观察患者的骨折愈合时间、复位丢失、内固定稳定性、骨关节炎发生情况等,并于术后12个月采用美国足踝外科协会(AOFAS)踝与后足评分进行临床疗效评价。结果:18例患者获得随访,时间18~36 (22.5±4.3)个月。术后18例切口均Ⅰ期愈合。复查X线片示踝关节均获解剖复位。所有骨折愈合,愈合时间12~18 (13.4±2.4)周。术后12~17(14.5±1.3)周可正常行走并返回岗位。随访期间无复位丢失、内固定物松动及断裂等并发症发生,未出现骨不连、骨不愈合、骨关节炎的影像学表现。术后12个月AOFAS评分为92.4±6.7,其中优15例,良3例。结论:桡骨远端T形钢板治疗垂直型内踝骨折,具有固定牢靠、符合生物力学要求、钢板解剖更贴符、软组织刺激少等优势,术后可实现早期功能锻炼,功能恢复良好,是治疗垂直型内踝骨折比较理想的选择。Objective:To explore clinical effects of distal radius T-plates in treating vertical shear medial malleolus fractures.Methods:From March 2014 and March 2016,clinical data of 18 patients with vertical shear medial malleolus fractures were retrospectively analyzed,including 12 males and 6 females aged from 22 to 63 years old with an average of(41.3±5.2) years old;6 patients were on the left side and 12 patients were on the right side;5 patients combined with external malleolus fractures and 13 patients combined with external malleolus and posterior malleolus fractures.All patients were treated with distal radius T-plate fixation.Fracture healing time,loss of reduction,stability of internal fixation,occurrence of osteoarthritis were observed,postoperative AOFAS score at 12 months was used to evaluate clinical effects.Results:All patients were followed up from 18 to 36 months with an average of(22.5±4.3) months.All incisions healed well at stage Ⅰ.Review of X-ray showed that ankle joints were got anatomically reset.All fractures healed well ranged from 12 to 18 weeks with an average of(13.4±2.4) weeks.After surgery,patients resumed normal walking from 12 to 17 weeks with an average of(14.5±1.3) weeks.No complications such as loss of reduction,loosening or rupture of internal fixation,nonunion of fracture,radiographic appearance of osteoarthritis occurred during following-up.AOFAS scores was 92.4±6.7 at 12 months after operation,and 15 patients got excellent result,3 moderate.Conclusion:Distal radius T-plates for treatment of vertical shear medial malleolus fractures have advantages of firm fixation,conforming to biomechanical requirements,better matching with plate anatomy,and less soft tissue stimulation.It could achieve early function exercise,obtain good recovery of function,and it is an ideal choice for the treatment of vertical shear medial malleolus fractures.

关 键 词：踝关节 骨折 骨折固定术 

分 类 号：R683.42[医药卫生—骨科学]