髓内髓外组合式固定治疗累及踝关节的胫骨干骨折  

Combined intra-and extramedullary fixation foRthe treatment of tibial shaft fractures involving the ankle joint

作　　者：王朝晖 曹书杰 刘建伟 张亮 刘从威 熊劲芝 Wang Zhaohui;Cao Shujie;Liu Jianwei;Zhang Liang;Liu Congwei;Xiong Jingzhi(Department of Orthopaedic Trauma,the First People’s Hospital of Chenzhou,Affiliated to Hengyang Medical School,University of South China,Chenzhou,Hunan Province 423000,China)

机构地区：[1]南华大学衡阳医学院附属郴州市第一人民医院创伤骨科,湖南郴州423000

出　　处：《创伤外科杂志》2024年第11期836-841,共6页Journal of Traumatic Surgery

基　　金：南华大学衡阳医学院附属郴州市第一人民医院技术项目(2020A35)。

摘　　要：目的探讨髓内髓外组合式内固定治疗累及踝关节的胫骨干骨折的临床效果。方法回顾性分析2018年1月—2023年1月南华大学衡阳医学院附属郴州市第一人民医院创伤骨科收治的37例累及踝关节的胫骨干骨折患者,男性23例,女性14例;年龄18~71岁,平均45.1岁;摔伤21例,道路交通伤13例,砸伤3例;闭合性骨折32例,开放性骨折5例;26例合并同侧腓骨骨折。隐匿性踝关节骨折共18例。16例采用髌上入路髓内钉联合空心螺钉或钢板髓内髓外组合式内固定(组合式固定组),21例采用锁定钢板内固定(锁定钢板组)。记录受伤至手术时间、手术时间、术中出血量、术中透视次数、术后并发症、骨折愈合时间和美国足踝外科协会(AOFAS)踝-后足评分。结果术后随访12~34个月,平均20.1个月,患者均获骨性愈合,骨折愈合时间3~8个月,平均4.8个月。组合式固定组的手术时间(93.8±15.1)min、透视次数(15.1±2.4)次多于锁定钢板组(79.5±13.3)min、(6.6±1.7)次(P<0.05),但其受伤至手术时间(4.9±1.4)d、术中出血量(86.3±15.9)mL少于锁定钢板组的(7.2±1.3)d和(118.1±30.6)mL(P<0.05)。并发症发生率、骨折愈合时间及末次随访踝关节功能评分两组间差异无统计学意义(P>0.05)。结论髌上入路髓内钉联合空心螺钉或钢板髓内髓外组合式内固定是治疗简单累及踝关节的胫骨干骨折简便、微创、安全有效的方法,需较多透视是其不足。Objective To investigate the clinical effect of concomitant tibial shaft and ankle fractures by suprapatellaRintramedullary nailing combined with extramedullary cannulated screws oRplate.Methods From Jan.2018 to Jan.2023,37 patients with concomitant tibial shaft and ankle fractures treated in the Department of Orthopaedic Trauma,the First People’s Hospital of Chenzhou,Affiliated to Hengyang Medical School,University of South China,were retrospectively evaluated,including 23 males and 14 females aged 18-71(mean 45.1)years.Among them,there were 21 falls,13 road traffic injuries,and 3 crash injuries;32 were closed fractures and 5 were open;26 cases had ipsilateral distal tibia fractures;18 ankle fractures were occult on X-ray films.Of the patients,16 were managed by suprapatellaRintramedullary nailing combined with plates oRcannulated screws(combined fixation group),and the otheR21 by locking plates(locking plate group).The interval time from injury to surgery,operation time,intraoperative blood loss and frequency of fluoroscopy,complications,fracture union time,and functional outcomes by AOFAS ankle-foot score were analyzed.Results All patients were followed up foR12-34(mean 20.1)months.Fracture union was observed in all of them in 3-8(mean 4.8)months.Compared with the locking plate group,the combined fixation group showed longeRoperation time(min,93.8±15.1 vs.79.5±13.3)and more frequent intraoperative fluoroscopy(times,15.1±2.4 vs.6.6±1.7),but shorteRinjury to surgery time(d,4.9±1.4 vs.7.2±1.3)and intraoperative blood loss(mL,86.3±15.9 vs.118.1±30.6,all P<0.05).The fracture union time,incidence of complications,and AOFAS ankle-foot score at the last follow-up revealed no significant difference between the two groups(P>0.05).Conclusion SuprapatellaRintramedullary nailing combined with extramedullary cannulated screws oRplates foRthe treatment of tibial shaft fractures involving the ankle joint is simple,minimally invasive,safe,and effective;the shortcoming is need of more intraoperative fluoroscopy.

关 键 词：胫骨干骨折 踝关节骨折 髓内钉 髌上入路 组合固定 

分 类 号：R687.3[医药卫生—骨科学]