胫骨远端逆行髓内钉内固定治疗胫骨远端近踝部骨折  

Treatment of proximal malleolar fracture of distal tibia with retrograde intramedullary nail fixation

作　　者：高明明 刘庆军[1] 朱建非 石朋文 林成寿 许胜贵 林需枰 洪加源[1] 丁真奇[1] Gao Mingming;Liu Qingjun;Zhu Jianfei;Shi Pengwen;Lin Chengshou;Xu Shenggui;Lin Xuping;Hong Jiayuan;Ding Zhenqi(Department of Orthopaedics,909th Hospital(Southeast Hospital Affiliated to Xiamen University),Zhangzhou 363000,China;Department of Orthopaedics,Huaian 82 Hospital,Huaian 223001,China;Department of Traumatic Orthopaedics,Ningde Mindong Hospital,Ningde 355000,China;Department of Spinal Surgery,Fujian Longyan First Hospital,Longyan 364000,China)

机构地区：[1]第九〇九医院(厦门大学附属东南医院)骨科,漳州363000 [2]淮安八十二医院骨科,淮安223001 [3]宁德市闽东医院创伤骨科,宁德355000 [4]福建省龙岩市第一人民医院脊柱外科,龙岩364000

出　　处：《中华骨科杂志》2024年第19期1280-1287,共8页Chinese Journal of Orthopaedics

基　　金：福建省自然科学基金(2021J011448)。

摘　　要：目的观察胫骨远端逆行髓内钉内固定治疗胫骨远端近踝部骨折的临床疗效。方法对40例成人胫骨进行三维CT检查,测量胫骨远端后内侧后翻角度、扭转高度、置钉安全区高度等解剖学指标。依托人体骨骼模型解剖数据库研制出符合国人胫骨远端近踝部骨骼解剖特点的胫骨远端逆行髓内钉及其配套器械。回顾性分析2019年6月至2023年6月于第九〇九医院接受逆行髓内钉内固定治疗的胫骨远端近踝部骨折患者25例,男18例、女7例,年龄(41.3±10.8)岁(范围22~65岁)。以样本量1∶1根据性别和年龄进行配对,匹配同期接受顺行髓内钉内固定治疗的胫骨远端近踝部骨折患者25例,男20例、女5例,年龄(41.2±9.4)岁(范围19~60岁)。观察复位质量、术后Baird-Jackson评分、美国骨科足踝学会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分、踝关节活动范围及并发症情况。结果所有患者均顺利完成手术并获得随访,随访时间为(14.4±3.5)个月(范围12~24个月)。逆行髓内钉组术中出血量和住院时间为(33.12±7.38)ml和(10.32±1.75)d,小于顺行髓内钉组的(49.04±10.22)ml和(13.16±2.69)d,差异有统计学意义(P<0.05)。逆行髓内钉组复位质量优23例、良2例,顺行髓内钉组优17例、良8例,逆行髓内钉组复位质量优的占比高于顺行髓内钉组,差异有统计学意义(χ^(2)=4.500,P=0.034)。逆行髓内钉组术后3个月Baird-Jackson评分和AOFAS踝与后足评分分别为(85.6±2.5)分和(85.8±3.3)分、均小于术后1年的(95.3±3.1)分和(95.8±3.6)分,差异有统计学意义(P<0.05)。顺行髓内钉组术后3个月Baird-Jackson评分和AOFAS踝与后足评分分别为(85.1±3.3)分和(86.1±2.5)分,均小于术后1年的(95.2±2.7)分和(94.9±3.5)分,差异有统计学意义(P<0.05)。两组术后3个月和术后1年的Baird-Jackson评分和AOFAS踝与后足评分组间比较差异无统计学意义(P>0.05)。末次随访时两组患者无一例�Objective To observe the clinical effect of retrograde distal tibial intramedullary nail fixation in the treatment of proximal ankle fracture of the distal tibia.Methods A three-dimensional CT examination of 40 adult tibias was performed to measure anatomical indicators such as the posterior medial posterior torsion angle of the distal tibia,the height of torsion,and the height of the safety zone for nail placement.Based on the anatomy database of the human skeleton model,a retrograde distal tibial nail and its supporting instruments were developed in accordance with the anatomical characteristics of the distal tibia and the proximal ankle of Chinese people.From June 2019 to June 2023,a total of 25 patients with distal tibial proximal ankle fractures treated with retrograde intramedullary nail internal fixation in the 909th Hospital were retrospectively analyzed.There were 18 males and 7 females,aged 41.3±10.8 years(range,22-65 years).The sample size was 1:1 matched according to gender and age.Twenty-five patients with distal tibial proximal ankle fractures who underwent antegrade intramedullary nail fixation during the same period were matched,including 20 males and 5 females,aged 41.2±9.4 years(range 19-60 years).The reduction quality,postoperative Baird-Jackson score,American Orthopaedic Foot and Ankle Society(AOFAS)ankle and hindfoot score,ankle range of motion and complications were observed.Results All patients were successfully operated and followed up for 14.4±3.5 months(range,12-24 months).The intraoperative blood loss and hospitalization time in retrograde intramedullary nail group were 33.12±7.38 ml and 10.32±1.75 d,less than 49.04±10.22 ml and 13.16±2.69 d in antegrade intramedullary nail group,and the difference was statistically significant(P<0.05).The reduction quality was excellent in 23 cases and good in 2 cases in the retrograde intramedullary nail group,and was excellent in 17 cases and good in 8 cases in the anterograde intramedullary nail group.The proportion of excellent reduction qua

关 键 词：胫骨骨折 骨折闭合复位 骨折固定术 髓内 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]