外固定器结合有限内固定治疗胫骨远端骨折

External Fixator Combined with Limited Internal Fixation for Distal Tibial Fractures

目的观察外固定器结合有限内固定治疗胫骨远端骨折的临床效果及探讨该方法在胫骨远端骨折治疗中的价值。方法采用Orthofix外固定器结合有限内固定治疗胫骨远端骨折48例,首先将腓骨骨折复位固定,恢复下肢的长度及力线,然后对胫骨远端骨关节面骨折通过有限的切开复位,空心钉或克氏针固定,最后采用Hybrid环形或铰链式外固定器固定。对其临床资料进行回顾性分析。结果随访46例,随访时间6～47个月,所有骨折均愈合,踝活动范围平均背伸20°,跖屈40°。并发症包括针道感染12例,创伤性关节炎4例。根据Helfer踝关节功能评定标准:优20例,良16例,差10例,优良率为78.3%。结论外固定器结合有限内固定治疗胫骨远端骨折可有效地减少感染等并发症,提高治疗效果,是一种比较安全、可靠的治疗方法。

Objective To observe the results of treatment of distal tibial fracture with the external fixator combined with limited internal fixation and study the clinical value of this protocol. Methods From September 2002 to December 2005, 48 patients with distal tibial fracture were treated with Orthofix external fixator combined with limited internal fixation. According to AO classification, type A was in 9 patients,type B in 13 and type C in 26. Open fractures were found in 19 patients. Gustilo type Ⅰ was in 12 patients,type Ⅱ in 4 and type Ⅲ in 3. Firstly the fibular fractures were reduced and fixed with plate to restore the length and the alignment of the limb. Secondly the displaced articular fractures of distal tibia were reduced and fixed with thin cannulated screws or K - wires by limited means. At last, a hinged external fixator or a sheffield hybrid external fixator was used to enhance the tibia stability. The clinical data were collected and a retrospective analysis was performed. Results Forty - six patients＇were followed up for 6 to 47 months. All fractures were united. The averaged dorsiflexion was 20 degree and the averaged plantar flexion was 40 degree. Complications included pin tract infection in 12 patients and the posttraumatic arthritis in 4 patients. According to Heifer criterion for clinical result, the excellent result was achieved in 20 patients,good in 16 and fair in 10 with the excellent and good rate at 78.3 %. Conclusion External fixator combined with limited internal fixation can decrease the complication of deep infection and achieve good clinical result in management of distal tibial fractures. It is a safer and more reliable way in the treatment of distal tibial fractures.