胫骨远端内侧钩微型钢板治疗垂直型内踝骨折的临床研究  

Clinical study of the treatment in the vertical medial malleolus fractures of the distal tibia with the medial hook mircoplate

作　　者：祁义民 曾逸文[1] 赵磊[1] 徐晨阳[1] 梁斌[1] 王强[1] 杨蓊勃[1] 隋吉生[1] Qi Yimin;Zeng Yiwen;Zhao Lei;XuChenyang;Liang Bin;Qiang;Yang Wengbo;Sui Jisheng(Department of Orthopaedic Surgery,Nanjing First Hospital,Nanjing Medical University Nanjing Jiangsu,210006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)骨科,江苏南京210006

出　　处：《生物骨科材料与临床研究》2021年第1期27-30,35,共5页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的分析胫骨远端内侧钩状微型钢板在治疗垂直型内踝骨折中的临床疗效。方法回顾性分析本院骨科自2016年11月至2018年12月采用胫骨远端内侧钩微型钢板治疗21例垂直型内踝骨折的患者,统计手术时间、术中出血量,观察术后并发症及骨折愈合时间;比较手术前后踝穴间隙一致性、距骨-小腿角、距骨有无倾斜;根据Kofoed踝关节评分标准、Olerud和Molander踝关节骨折评分系统、踝关节活动度评估踝关节功能。结果 21例患者均得到随访,随访时间10~18个月,平均随访15.3个月。手术时间为40~125 min,平均63.5 min;术中出血量为50~180 mL,平均83.6 m L。术后出现1例浅表皮肤感染,2例创伤性关节炎,未见内固定松动、螺钉退钉、钢板断裂等并发症。21例全部骨性愈合,平均愈合时间2.8个月(2.0~3.5个月)。术后1周复查X线,未见距骨倾斜不稳,踝穴间隙一致性恢复较好。术后1周距骨-小腿角(80.4±1.2)°较术前(73.5±4.8)°明显改善(=4.38,<0.05)。术后第1个月、3个月、1年时Kofoed踝关节评分、Olerud和Molander踝关节骨折评分、踝关节活动度较术前均明显改善(<0.05)。末次随访时根据Kofoed踝关节优良评分标准,优13例,良6例,差2例,优良率为90.48%。结论胫骨远端内侧钩微型钢板治疗垂直型内踝骨折,具有解剖复位骨折、有效支撑托举骨折块、防止垂直剪切力造成的骨折移位失效等优点,是治疗此类骨折较合适的选择。Objective To analyze the clinical effect of the medial hook microplate at the distal tibia in the clinical application of vertical medial malleolus fracture.Methods A retrospective analysis of 21 patients with vertical medial malleolus fractures treated with medial hook microplate at the distal tibia from November 2016 to December 2018 in our department of orthopedics was performed.The operation time and intraoperative blood loss were counted,and postoperative complications and fracture healing time were observed.To compare the ankle acupoint consistency,talus-calf angle,talar with or without tilt before and after surgery.Ankle function was evaluated according to Kofoed ankle scoring standard,Olerud and Molander ankle fracture scoring system,and ankle mobility.Results All the 21 patients were followed up for 10 to 18 months,with an average of 15.3 months.The operation time was 40-125 min,with an average of 63.5 min.The intraoperative blood loss was 50-180 mL,with an average of 83.6 mL.There were 1 case of superficial skin infection and 2 cases of traumatic arthritis after operation.There were no complications such as loosening of internal fixation,withdrawal of screws and broken plates.All the 21 cases had bony healing,with an average healing time of 2.8 months(2.0-3.5 months).X-rays were reviewed at 1 week after operation,and no talar instability was observed,and the consistency of ankle acupoints was better.The talus-calf angle(80.4±1.2)°at 1 week postoperatively was significantly improved compared with that before operation(73.5±4.8)°(t=4.38,P<0.05).The Kofoed ankle score,Olerud and Molander ankle fracture scores,and ankle mobility at 1 month,3 months and 1 year after surgery were significantly improved compared with those before surgery(P<0.05).At the last follow-up,according to the Kofoed ankle score standard,13 cases were excellent and 6 cases were good,with an excellent and good rate of 90.48%.Conclusion The treatment of vertical medial malleolus fractures with the medial hook mircoplate of the distal

关 键 词：胫骨远端 内侧钩微型钢板 垂直 旋后-内收型骨折 

分 类 号：R683.42[医药卫生—骨科学]