多轴锁定接骨板置入治疗较短胫骨远端干骺端骨折:同一机构1年32例资料回顾

Polyaxial locking plating for fractures of the distal tibia with very short metaphyseal fragments: Retrospective analysis of 32 cases from one institution in 1 year

背景:经皮微创单轴锁定接骨板固定技术已被广泛应用于治疗复杂的胫骨远端干骺端骨折。对于比较小的胫骨远端干骺端骨折,单轴锁定接骨板有时无法提供足够的固定强度和稳定。目的:观察多轴锁定接骨板治疗较短的胫骨远端干骺端骨折块的临床应用效果。方法:应用多轴锁定接骨板治疗32例伴较短干骺端骨折块的胫骨远端骨折,骨折部位距离胫骨远端关节面的平均长度为11mm,共有9例开放性骨折。所有骨折均涉及胫骨远端的干骺端,其中14例累及踝部。21例胫骨远端骨折使用经皮微创接骨板技术治疗,11例使用传统的切开复位内固定技术治疗。观察切口愈合情况及围手术期并发症,随访直到骨折愈合。随访采用AOFAS踝部评分标准对结果进行评估。结果与结论:所有骨折均愈合,愈合的时间为10～20周,平均14周。经皮微创接骨板技术组的骨折愈合时间明显短于切开复位内固定组(P<0.01)。闭合性骨折组的骨折愈合时间明显短于开放性骨折组(P<0.05)。患者AOFAS踝关节评分为72～98分,平均功能得分为87.3分。10例患者出现骨折固定后并发症。提示在某些非常短的关节部位的骨折或干骺端粉碎性骨折,多轴锁定接骨板系统可以提供高强度的成角和轴向稳定,并且并发症较少,因此对于这些特殊的胫骨远端干骺端骨折,多轴锁定接骨板具有良好的应用价值。

BACKGROUND： Minimally invasive plate osteosynthesis （MIPO） has become widely used for the treatment of complex fractures of the distal part of the tibia. For relatively small distal tibia fracture fragment, a monoaxial locking plate with fixed-trajectory locking screws sometimes may not provide anticipated fixation stability for the distal fragment. OBJECTIVE： To evaluate primary clinical outcomes of fractures of the distal tibia with very short metaphyseal fragments treated with polyaxial locking plating. METHODS： A total of 32 adult patients with very short metaphyseal fragments in fractures of the distal tibia were treated with a polyaxial locking plate. The average distance from the distal extent of the fracture to the tibial plafond was 11 mm. There were 9 cases of open fractures. All fractures involved the metaphyseal part of the distal tibia, and in 14 cases the fracture extended distally into the ankle. Of them, 21 patients were treated with MIPO, and 11 with traditional open reduction and internal fixation. The incision and complications were observed. The patients were followed up until fracture healing. The results were evaluated by AOFAS scores. RESULTS AND CONCLUSION： All fractures healed. The average time to union for all fractures was 14 weeks （range, 10–20 weeks）. The average healing time for fractures using the MIPO technique was significantly shorter than traditional technique （P〈0.01）. Closed fractures healed rapidly compared with open fractures （P〈0.05）. Using the AOFAS ankle-hindfoot scale, the average functional score was 87.3 points （range, 72–98 points）. All results demonstrated that the polyaxial locking plate offering more fixation versatility can provide a high degree of angular and axial stability to short articular segments and metaphyseal comminution, with low incidence of complications. Therefore, it can be considered a feasible and worthwhile method of stabilization and recommended for the treatment of these special type fractures of the distal tibia.