胫骨远端关节外骨折微创钢板接骨术后胫骨旋转对膝、踝关节功能影响的研究  

Effect of tibial rotation on knee and ankle function in patients with extra-articular distal tibial fractures after minimally invasive plate osteosynthesis treatment

作　　者：张剑平 刘晖[1] 徐维臻 熊远飞 张金辉 吴进[1] ZHANG Jianping;LIU Hui;XU Weizhen;XIONG Yuanfei;ZHANG Jinhui;WU Jin(Department of Orthopaedics,the 909th Hospital,Dongnan Hospital of Xiamen University,Zhangzhou Fujian,363000,P.R.China)

机构地区：[1]第九〇九医院,厦门大学附属东南医院骨科,福建漳州363000

出　　处：《中国修复重建外科杂志》2024年第10期1236-1241,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨微创钢板接骨术(minimally invasive plate osteosynthesis,MIPO)治疗胫骨远端关节外骨折术后胫骨旋转对患者膝、踝关节功能的影响。方法回顾性分析2021年1月—2022年12月接受MIPO治疗并符合选择标准的45例胫骨远端关节外骨折患者临床资料。男20例,女25例;年龄19~68岁,平均43.6岁。致伤原因:高处坠落伤11例,交通事故伤15例,重物砸伤7例,跌倒伤12例。受伤至入院时间1~6 h,平均3.7 h。单纯胫骨骨折28例,合并同侧腓骨骨折17例。开放骨折9例,闭合骨折36例。胫骨远端骨折国际内固定研究协会/美国骨创伤协会(AO/OTA)分型:43A1型12例,43A2型17例,43A3型16例。随访期间采用下肢功能评分(LEFS)、美国矫形足踝协会(AOFAS)评分、膝关节损伤与骨关节炎评分(KOOS)分别评估下肢以及踝、膝关节功能,测量膝、踝关节活动度(range of motion,ROM),简明健康调查量表(SF-36量表)评估患者生活质量。摄踝关节正侧位X线片评估骨折愈合情况。CT检查测量双下肢胫骨旋转角度并计算患侧与健侧差值,旋转角度差值绝对值≥10°判定为胫骨旋转不良。根据是否胫骨旋转不良,将患者分为正常组和旋转不良组进行疗效比较。结果术后患者切口均Ⅰ期愈合,无早期并发症发生。患者均获随访,随访时间12~26个月,平均18.6个月。影像学复查示骨折均愈合,愈合时间9~14周,平均11.2周。末次随访时,LEFS评分为60~68分,平均62.3分;AOFAS评分为89~97分,平均92.6分;KOOS评分为158~164分,平均161.3分。踝关节ROM:跖屈40.0°~45.0°,平均42.8°;背伸10.5°~22.0°,平均17.7°。膝关节ROM:屈曲130.0°~135.0°,平均132.6°;伸直–8.8°~–5.0°,平均–7.1°。患者生活质量SF-36量表评分为89~93分,平均90.7分。45例患者胫骨旋转角差值绝对值为2.6°~17.3°,平均8.9°;15例(33.3%)胫骨旋转不良,其中内旋10例、外旋5例。旋转良好组与正常组术前合并腓骨骨折患者构成比以�Objective To investigate the effect of tibial rotation on knee and ankle function in the patients with extra-articular distal tibial fractures after minimally invasive plate osteosynthesis(MIPO)treatment.Methods A retrospective analysis was conducted on 45 patients with extra-articular distal tibial fractures who underwent MIPO between January 2021 and December 2022.There were 20 males and 25 females,aged from 19 to 68 years(mean,43.6 years).The causes of fractures included falling from heights in 11 cases,traffic accidents in 15 cases,bruising by a heavy object in 7 cases,and falling in 12 cases.The time from injury to hospitalization was 1-6 hours(mean,3.7 hours).There were 28 cases of simple tibial fractures and 17 cases of tibial fractures combined with ipsilateral fibular fractures;9 cases of open fractures and 36 cases of closed fractures.According to AO/Orthopaedic Trauma Association(AO/OTA)classification,the distal tibial fractures were classified as type 43A1 in 12 cases,type 43A2 in 17 cases,and type 43A3 in 16 cases.During follow-up,the Lower Limb Function Score(LEFS),American Orthopaedic Foot and Ankle Society(AOFAS)score,and Knee Injury and Osteoarthritis Score(KOOS)were used to evaluate the lower limb,ankle,and knee joint functions,respectively.The range of motion(ROM)of the knee and ankle joints was measured.The Short Form Health Survey(SF-36)was used to assess the quality of life of the patients.The fracture healing was observed by anteroposterior and lateral X-ray films of the ankle joint.The bilateral tibial rotation angles were measured on CT and the differences between the affected and healthy sides were caculated.The difference≥10°was judged as tibial malrotation.According to whether there was tibial malrotation,the patients were allocated into a normal group and a malrotation group for efficacy comparison.Results The incisions of all patients healed by first intention without any early complications.All patients were followed up 12-26 months(mean,18.6 months).Imaging re-examination showed

关 键 词：微创钢板接骨术 胫骨远端骨折 关节外骨折 旋转不良 关节功能 

分 类 号：R687.3[医药卫生—骨科学]