交锁髓内钉固定腓骨下段骨折合并下胫腓损伤  

Interlocking intramedullary nail for distal fibular fracture complicated with inferior tibiofibular injury

作　　者：徐政 吕飞 徐蔚蔚 董献成 杜建伟 沈书明 XU Zheng;LV Fei;XU Wei-wei;DONG Xian-cheng;DU Jian-wei;SHEN Shu-ming(Department of Orthopedics,Yangzhou First People's Hospital,Affiliated Hospital of Yangzhou University,Yangzhou 225000,China)

机构地区：[1]扬州大学附属医院(扬州市第一人民医院)骨科,江苏扬州225000

出　　处：《中国矫形外科杂志》2024年第14期1318-1321,共4页Orthopedic Journal of China

摘　　要：[目的]探讨交锁髓内钉联合胫腓螺钉固定腓骨下段骨折合并下胫腓损伤的临床疗效。[方法]回顾性分析2019年1月—2022年2月在本院应用交锁髓内钉治疗的腓骨下段骨折合并下胫腓损伤29例患者的临床资料。评价临床及影像资料。[结果]所有患者均顺利完成手术,手术时间(51.8±10.3)min,术中出血量(68.3±14.3)ml,切口总长度(42.5±3.6)mm,随访时间(13.7±2.4)个月。随时间推移,患者VAS评分、AOFAS评分及踝ROM均显著改善(P<0.05)。影像方面,与术前相比,患者术后6个月及末次随访下胫腓骨重叠(tibiofibular overlap,TFO)[(2.1±0.7)mm,(8.1±1.3)mm,(8.0±1.1)mm,P<0.001]、距骨小腿角(talocrural angle,TCA)[(73.9±4.2)°,(83.1±3.0)°,(82.4±2.9)°,P<0.001]均显著增加,而下胫腓间隙(tibiofibular clear space,TFCS)[(8.3±1.3)mm,(4.3±0.5)mm,(4.4±0.5)mm,P<0.001]显著减小。[结论]交锁髓内钉联合下胫腓螺钉可有效治疗腓骨下段骨折合并下胫腓损伤,具有切口小,出血少,抗旋转,且下胫腓固定可靠等优势。[Objective]To investigate the clinical outcomes of interlocking intramedullary nail combined with tibiofibular screw for fixation of distal fibular fracture complicated with inferior syndesmosis injury.[Methods]A retrospective study was conducted on 29 patients who had distal fibular fracture fixed with interlocking intramedullary nail,and tibiofibular syndesmosis fixed by tricortical screw in our hospital from January 2019 to February 2022.The clinical and imaging data were evaluated.[Results]All patients were operated successfully with operation time of(51.8±10.3)min,the intraoperative blood loss of(68.3±14.3)ml,the total incision length of(42.5±3.6)mm,and followed up for(13.7±2.4)months.The VAS score,AOFAS score and ankle ROM were significantly improved over time(P<0.05).In terms of imaging,compared with those preoperatively,the inferior tibiofibular overlap(TFO)[(2.1±0.7)mm,(8.1±1.3)mm,(8.0±1.1)mm,P<0.001]and talocrural angle(TCA)[(73.9±4.2),(83.1±3.0),(82.4±2.9),P<0.001]increased significantly 6 months after surgery and at the latest follow-up,while the tibiofibular clear space(TFCS)decreased significantly[(8.3±1.3)mm,(4.3±0.5)mm,(4.4±0.5)mm,P<0.001].[Conclusion]The interlocking intramedullary nail combined with tibiofibular screw does effectively treat distal fibular fracture complicated with inferior tibiofibular syndesmosis injury,with advantages of small incision,less bleeding,anti-rotation and reliable fixation of the syndesmosis.

关 键 词：腓骨下段骨折 髓内钉 下胫腓联合 内固定 

分 类 号：R683.42[医药卫生—骨科学]