胫骨髓内钉联合腓骨钢板治疗同平面胫腓骨中下段骨折术中复位固定顺序的探讨  

Sequence of reduction and fixation in the treatment of middle and lower tibiofibular fractures on the same plane using tibial intramedullary nailing plus fibular plating

作　　者：赵镒汶 陈逸 王珂杰[1] 戴小宇 王锋[1] 胡新宇[1] 马文明[1] Zhao Yiwen;Chen Yi;Wang Kejie;Dai Xiaoyu;Wang Feng;Hu Xinyu;Ma Wenming(Department of Traumatic Orthopedics,The First People's Hospital of Changzhou,Changzhou 213000,China)

机构地区：[1]常州市第一人民医院创伤骨科,213000

出　　处：《中华创伤骨科杂志》2020年第11期933-938,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的对比研究胫骨髓内钉联合腓骨钢板治疗同平面胫腓骨中下段骨折术中优先复位固定腓骨与胫骨的疗效。方法回顾性分析自2016年1月至2017年12月常州市第一人民医院创伤骨科收治的58例同平面胫腓骨中下段骨折患者资料。男38例,女20例;年龄20~65岁,平均40岁。左侧30例,右侧28例。骨折AO分型:42-A型27例,42-B型18例,42-C型13例。根据术中采用的不同复位固定顺序,将患者分为2组:腓骨组33例(腓骨优先复位固定),胫骨组25例(胫骨优先复位固定)。胫骨骨折采用髓内钉固定,腓骨骨折采用钢板固定。比较两组手术时间、胫骨闭合复位率、髓内钉动力化率、骨折愈合时间及术后并发症情况。结果所有患者术后获12~24个月(平均17.2个月)随访。腓骨组手术时间为(96±15)min,较胫骨组(116±19)min缩短,差异有统计学意义(P<0.05)。胫骨闭合复位率腓骨组为84.8%(28/33),胫骨组为60.0%(15/25),差异有统计学意义(P<0.05)。两组患者术后髓内钉动力化率、骨折愈合时间及术后并发症发生率差异均无统计学意义(P>0.05)。结论胫骨髓内钉联合腓骨钢板治疗同平面胫腓骨中下段骨折效果良好,当骨折线位于胫骨非狭窄段时,术中先行腓骨复位固定有助于胫骨的复位和置钉,能提高手术效率,但并不增加骨折愈合时间,较先行胫骨复位固定更有优势。Objective To explore the sequence of reduction and fixation in the treatment of middle and lower tibiofibular fractures on the same plane using tibial intramedullary nailing plus fibular plating.Methods A retrospective analysis was performed of the 58 patients with middle and lower tibiofibular fractures on the same plane from January 2016 to December 2017.They were 38 males and 20 females,aged from 20 to 65 years(average,40 years).The left side was affected in 30 cases and the right in 28.By the AO classification,27 cases were type 42-A,18 ones type 42-B and 13 ones type 42-C.Of them,33 had the fibula reduced and fixated first(the fibular group)while 25 had the tibia reduced and fixated first(the tibial group).The 2 groups were compared in terms of operation time,rate of tibial closed reduction,rate of dynamization of intramedullary nails,fracture healing time and postoperative complications.Results All the patients were followed up for 12 to 24 months(average,17.2 months).The operation time in the fibular group was 96 minutes±15 minutes,significantly shorter than that in the tibial group(116 minutes±19 minutes)(P<0.05).The rate of tibial closed reduction was 84.8%(28/33)in the fibular group and 60.0%(15/25)in the tibial group,presenting a significant difference(P<0.05).There were no significant differences between the 2 groups in the rate of dynamization of intramedullary nails,fracture healing time or postoperative complications(P>0.05).Conclusions Tibial intramedullary nailing plus fibular plate osteosynthesis is an effective treatment for the middle and lower tibiofibular fractures on the same plane.When the fracture line is not located in the narrow segment of the tibia,reduction and fixation of the fibula first is advantageous over reduction and fixation of the tibia first,because it can facilitate tibial reduction and nail placement and improve surgical efficiency without increasing the fracture healing time.

关 键 词：胫骨骨折 腓骨 骨钉 骨折固定术 内 复位顺序 

分 类 号：R687.3[医药卫生—骨科学]