前外侧L形解剖锁定钢板治疗胫骨中下段螺旋形骨折合并后踝骨折的疗效  

The effect of anterolateral L-shaped anatomical locking plate in the treatment of spiral fracture of middle-loweRtibia with posterioRmalleolaRfracture

作　　者：王传鑫 李景银[1] 余文举 马亮 WANG Chuan-xin;LI Jing-yin;YU Wen-ju;MA Liang(Dept of Orthopaedics,the Affiliated Hospital of Shandong University of TCM,Jinan,Shandong 250014,China;the First Clinical Medical College,Shandong University of TCM,Jinan,Shandong 250014,China)

机构地区：[1]山东中医药大学附属医院骨科,山东济南250014 [2]山东中医药大学第一临床医学院,山东济南250014

出　　处：《临床骨科杂志》2022年第2期276-279,共4页Journal of Clinical Orthopaedics

基　　金：中国博士后科学基金第68批面上资助二等项目(编号:2020M682220);中国博士后科学基金第14批特别资助项目(编号:2021T140423);山东中医药大学附属医院青年创新团队项目;齐鲁卫生与健康杰出青年人才培养工程。

摘　　要：目的探讨前外侧L形解剖锁定钢板治疗胫骨中下段螺旋形骨折合并后踝骨折的疗效。方法采用前外侧L形解剖锁定钢板治疗29例胫骨中下段螺旋形骨折合并后踝骨折患者。记录切口长度、术中出血量、手术时间、住院费用、骨痂形成时间、骨折愈合时间、并发症发生情况。采用AOFAS踝-后足评分、疼痛VAS评分、踝关节活动度评价临床疗效。结果患者均获得随访,时间12~18(14.51±1.45)个月。切口总长度7~11(8.62±1.12)cm,术中出血量60~100(80.31±12.52)ml,手术时间75~102(86.34±7.14)min,住院费用3.1~4.2(3.55±0.36)万元。术中均未发生血管、神经等严重医源性损伤;术后均未发生感染、血栓、骨折延迟愈合或不愈合、内固定松动或断裂等并发症。骨痂形成时间5~9(6.97±1.12)周,骨折愈合时间10.5~16.0(12.47±1.24)周。术后12个月的AOFAS踝-后足评分、疼痛VAS评分均明显优于术后1个月(P<0.05)。末次随访时踝关节活动度:背伸18°~28°(23.56°±2.96°),跖屈36°~46°(41.10°±2.68°)。结论采用前外侧L形解剖锁定钢板治疗胫骨中下段螺旋形骨折合并后踝骨折,具有手术时间短、费用相对低、软组织剥离较少、内固定牢固、可早期功能锻炼、患者术后功能恢复较好等优势。Objective To investigate the efficacy of anterolateral L-shaped anatomical locking plate in the treatment of spiral fracture of middle-loweRtibia with posterioRmalleolaRfracture.Methods The 29 patients with spiral fractures of middle-loweRtibia combined with posterioRmalleolaRfractures were treated with anterolateral L-shaped anatomical locking plate.Incision length,intraoperative blood loss,operation time,hospitalization cost,callus formation time,fracture healing time and complications were recorded.The clinical efficacy was evaluated by AOFAS ankle-hindfoot score,pain VAS and ankle range of motion.Results All patients were followed up foR12~18(14.51±1.45)months.The total incision length was 7~11(8.62±1.12)cm,the intraoperative blood loss was 60~100(80.31±12.52)ml,the operation time was 75~102(86.34±7.14)min,and the hospitalization cost was 3.1~4.2(3.55±0.36)ten thousand yuan.No serious iatrogenic injury such as blood vessel and nerve occurred during the operation.There were no postoperative complications such as infection,thrombosis,delayed union oRnonunion,loosening oRfracture of internal fixation.The time of callus formation was 5~9(6.97±1.12)weeks,and the fracture healing time was 10.5~16.0(12.47±1.24)weeks.At 12 months afteRsurgery,AOFAS ankle-hindfoot score and pain VAS were significantly betteRthan those at 1 month postoperation(P<0.05).At the last follow-up,the ankle range of motion:dorsiflexion was 18°~28°(23.56°±2.96°),and plantar-flexion was 36°~46°(41.10°±2.68°).Conclusions In the treatment of spiral fracture of middle-loweRtibia combined with posterioRmalleolaRfracture,anterolateral L-shaped anatomical locking plate has the advantages of short operation time,relatively low cost,less soft tissue dissection,firm internal fixation,early functional exercise and betteRpostoperative functional recovery.

关 键 词：胫骨中下段骨折 后踝骨折 前外侧 L形钢板 

分 类 号：R683.42[医药卫生—骨科学] R687.32[医药卫生—外科学]