两种内固定治疗胫骨中下段螺旋形骨折的疗效比较  

Efficacy comparison of two kinds of internal fixation for treatment of middle-distal tibial spiral fractures

作　　者：张了然 马捷[1] 顾剑华[1] 王祥[1] 陶海荣[1] ZHANG Liao-ran;MA Jie;GU Jian-hua;WANG Xiang;TAO Hai-rong(Dept of Orthopaedics,Shanghai Ninth People′s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院骨科,上海200011

出　　处：《临床骨科杂志》2022年第5期736-740,共5页Journal of Clinical Orthopaedics

摘　　要：目的 比较拉力螺钉联合内侧钢板与前外侧钢板固定胫骨中下段螺旋形骨折的临床效果。方法 将95例胫骨中下段螺旋形骨折患者根据内固定方法的不同分为A组(采用拉力螺钉联合内侧钢板固定,50例)和B组(采用前外侧钢板固定,45例)。术后6、12个月采用AOFAS踝-后足评分系统评价踝关节功能,术后12个月测量踝关节活动度。结果 患者均获得随访,时间12~42(28.7±6.4)个月。骨痂形成时间、骨折愈合时间A组均短于B组(P<0.05)。术后开始负重时间A组早于B组(P<0.05)。AOFAS踝-后足评分:两组术后12个月均较术后6个月改善(P<0.05),术后6、12个月A组均优于B组(P<0.05)。术后12个月,踝关节背伸、跖屈活动度A组均大于B组(P<0.05);内翻、外翻两组比较差异均无统计学意义(P> 0.05)。末次随访时,两组踝关节功能均已恢复。结论 相较于前外侧钢板,拉力螺钉联合内侧钢板内固定治疗胫骨中下段螺旋形骨折,术后骨折复位好,软组织损伤少,固定牢靠,并发症少。Objective To compare the clinical effect of lag screws combined with medial plates and anterolateral plates on middle-distal tibial spiral fractures.Methods The 95 patients with middle-distal spiral fractures were divided into two groups. Fifty patients are treated with lag screws combined with medial plates(group A) and 46 patients were performed with anterolateral plates(group B). The ankle function was evaluated by AOFAS ankle-hindfoot scale at the 6,12 months after operation,and the ankle range of motion was measured at 12 months after operation.Results All patients were followed up for 12 ~ 42(28. 7 ± 6. 4) months. The callus formation time and fracture healing time in group A were shorter than those in group B(P< 0. 05). The starting weight-bearing time in group A was earlier than that in group B(P< 0. 05). AOFAS ankle-hindfoot scale:two groups were improved at 12 months postoperation,compared with the postoperative 6 months(P< 0. 05),and group A was better than group B at 6,12 months after operation(P< 0. 05). At 12 months after operation,ankle dorsiflexion and plantar flexion in group A were greater than those in group B(P< 0. 05);there was no significant difference in the varus and valgus between two groups(P>0. 05). At the last follow-up,the ankle function of two groups had restored.Conclusions Compared with the anterolateral plates,in the spiral fracture of the middle-lower tibia,lag screws combined with medial plates have the advantages of good fracture reduction,less soft tissue injuries,firm fixation and less complications.

关 键 词：胫骨中下段螺旋形骨折 拉力螺钉联合内侧钢板 前外侧钢板 内固定 

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