胫骨骨折髓内钉固定术后屈趾畸形(附5例临床分析)

Flexion Deformity of Toes Secondary to Internal Fixation of Tibia Fracture with Intramedullary Nail:A Report of 5 Cases

目的探讨胫骨骨折髓内钉固定术后屈趾畸形的发生机制及防治措施。方法362例胫骨骨折患者施行髓内钉固定手术,其中5例（1.4%）术后出现屈趾畸形,其临床表现为跛行、踝关节中立位足趾屈曲畸形,背伸时畸形加重,跖屈位畸形减轻。保守治疗无效,均行拇长屈肌及趾长屈肌肌腱＂Z＂形延长术。结果5例术后平均随访19.7（16-24）月。术后患者中立位足趾屈曲畸形消失,步态均恢复正常,踝关节背伸时足趾轻度屈曲畸形。拇长屈肌及趾长屈肌肌力5级。结论胫骨骨折髓内钉固定术后足趾屈曲畸形为少见并发症,其发生可能与术前拇长屈肌及趾长屈肌的损伤未得到有效治疗,术中髓内钉导针、扩髓器对拇长屈肌、趾长屈肌的损伤或术后小腿深后骨筋膜鞘内压力增高引起的肌肉缺血、纤维化改变有关;肌腱延长术是有效的治疗方法。

Objective To investigate the causes and treatment method of flexion deformity of toes secondary to internal fixation of tibia fracture with intramedullary nail.Methods A total of 362 cases with tibia fracture were performed internal fixation with intramedullary nail.In which 5 cases appeared flexion deformity of toes.The clinical manifestation was limp and flexion deformity of toes,which aggravated when the ankle was in dorsiflexion position and relieved when the ankle was in plantar flexion position.All the 5 cases were performed Z-shape cutting and lengthening the tendon of flexor hallucis longus（FHL） and flexor digitorum longus（FDL） after invalid conservative treatment.Results All patients were followed up for 16 to 24 months（average 19.7 months）.Normal gait was restored in all cases.Flexion deformity of toes disappeared in neutral position of ankle joint,and mild flexion deformity of toes existed in dorsal expansion position of ankle joint.The myodynamia of FHL and FDL was achieved grade 5.Conclusions The occurrence of flexion deformity of toes related to intramedullary nail fixation of tibia fracture is rare,and the causes are as follows： FHL and FDL was injured by fracture without effective treatment or by intraoperative operating with guide rod or reamer;ischemia and fibration of FHL and FDL was attributed to high pressure in the deep posterior compartment of the affected leg after operation.The procedure of lengthening FHL and FDL tendon is an effective treatment.