带锁腓骨髓内钉固定治疗合并腓骨骨折的胫骨远端关节外骨折的疗效分析  

Fixation with a locking fibular intramedullary nail for treatment of extra-articular distal tibial fracture complicated with fibular fracture

作　　者：熊远飞 刘晖[1] 张金辉 徐维臻 罗德庆[1] 吴进[1] Xiong Yuanfei;Liu Hui;Zhang Jinhui;Xu Weizhen;Luo Deqing;Wu Jin(Department of Orthopaedics,The 909th Hospital(Dongnan Hospital of Xiamen University),Zhangzhou 363000,China)

机构地区：[1]联勤保障部队第九〇九医院暨厦门大学附属东南医院骨科,漳州363000

出　　处：《中华创伤骨科杂志》2024年第8期724-727,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨带锁腓骨髓内钉固定治疗合并腓骨骨折的胫骨远端关节外骨折的疗效。方法回顾性分析2018年1月至2021年12月联勤保障部队第九〇九医院暨厦门大学附属东南医院骨科采用带锁腓骨髓内钉固定治疗的31例合并腓骨骨折的胫骨远端关节外骨折患者资料。男20例,女11例;年龄(41.5±15.7)岁;胫骨远端骨折AO分型:43A1型10例,43A2型10例,43A3型11例;开放性骨折11例,闭合性骨折20例。术后定期随访记录骨折愈合情况、腓骨力线角、胫距角及并发症发生情况;末次随访时采用Olerud Molander踝关节评分(OMAS)和美国足踝外科协会(AOFAS)踝-后足评分评定踝关节功能。结果31例患者术后获(17.5±3.3)个月的随访。所有患者骨折愈合良好,胫骨骨折愈合时间为(3.9±0.8)个月,腓骨骨折愈合时间为(3.6±0.9)个月,均未出现内固定失效。末次随访时腓骨力线角为1.8°±1.3°,胫距角为9.1°±2.3°,无腓骨旋转、短缩、分离移位;OMAS评分为(88.3±6.2)分,AOFAS踝-后足评分为(87.4±6.0)分。除2例患者因外踝处酸痛取出腓骨髓内钉远端松动的锁钉外,无其他相关并发症。结论带锁腓骨髓内钉固定可有效治疗合并腓骨骨折的胫骨远端关节外骨折,具有固定牢固、并发症少、创伤和软组织激惹小、临床疗效好等优势。ObjectiveTo evaluate the fixation with a locking fibular intramedullary nail for treatment of extra-articular distal tibial fracture complicated with fibular fracture(AO/OTA 43A).MethodsA retrospective study was conducted to analyze the data of 31 patients who had been treated by fixation with a locking fibular intramedullary nail for extra-articular distal tibial fracture complicated with fibular fracture at Department of Orthopaedics,The 909th Hospital of Joint Logistics Support Force between January 2018 and December 2021.There were 20 males and 11 females;(41.5±15.7)years in age;AO classification of the distal tibial fractures:10 cases of type 43A1,10 cases of type 43A2,and 11 cases of type 43A3;11 open fractures and 20 closed fractures.Fracture healing,fibular alignment,tibiotalar angle,and incidence of complications were regularly followed up and recorded after surgery.At the last follow-up,the ankle joint function was assessed using the Olerud Molander ankle score(OMAS)and the ankle-hindfoot score of American Orthopaedic Foot and Ankle Society(AOFAS).ResultsAll the 31 patients were followed up for(17.5±3.3)months after surgery.All of them achieved fine fracture union.The union time was(3.9±0.8)months for tibial fractures,and(3.6±0.9)months for fibular fractures.No internal fixation failure was observed.The last follow-up revealed the following:the fibular alignment was 1.8°±1.3°and the ankle tibiotalar angle 9.1°±2.3°;no fibular rotation,shortening,or separation displacement happened;the OMAS score was(88.3±6.2)points,and the AOFAS ankle-hindfoot score(87.4±6.0)points.Two patients required removal of the distal locking screw of the fibular intramedullary nail due to soreness around the lateral malleolus caused by screw loosening.There were no other related complications.ConclusionFixation with a locking fibular intramedullary nail is an effective treatment for extra-articular distal tibial fracture complicated with fibular fracture,demonstrating advantages of firm fixation,limited complications

关 键 词：胫骨骨折 骨折固定术 外科手术 微创性 腓骨骨折 髓内钉 

分 类 号：R687.3[医药卫生—骨科学]