单侧组合式外固定器治疗胫骨远端干骺端骨折

Unilateral combined external fixator in treatment of metaphyseal fractures of distal tibia

目的探讨应用单侧组合式外固定器结合选择正确的腓骨固定方法治疗胫骨远端干骺端骨折的效果。方法对31例胫骨远端干骺端骨折AO分型为A、B、C型骨折的患者进行治疗。腓骨骨折固定:A型不予固定;B、C型位于下胫腓联合上<5 cm者用1/3管形钢板内固定,高位者不予固定,B型下胫腓联合以下者可不予固定,C型下胫腓联合以下者行腓骨远端解剖钢板固定。胫骨骨折固定:A、B型行闭合复位外固定器固定,C型行切开克氏针内固定后再用外固定器固定。并对该方法的治疗结果进行评估。结果 31例均获随访,时间6～23(16±7)个月。关节面复位:优26例,良3例,差2例;肢体力线恢复:优27例,良3例,差1例。Phil-lips&Shwart踝关节评分为78～92(85±0.3)分。结论根据骨折类型,用单侧组合式外固定器固定结合选择正确的腓骨固定方式可有效避免伤口并发症,更好地恢复骨折端的解剖复位,固定牢固,疗效好。

Objective To study the effect of external fixation for metaphyseal fractures of distal tibia.Methods 31 cases with metaphyseal fractures of distal tibia that were surgically treated had been followed up.Type A associated fibular fractures were not fixed.Type B and C associated fibular fractures which located in 5cm higher than tibiofibular syndesmosis were fixed with 1/3 tubeular plate.The fibular fractures on upper section were not fixed.Type B which located below tibiofibular syndesmosis were not fixed,and type C which located below tibiofibular syndesmosis were fixed with anatomical plate of distal fibula.Tibial fixation： type A and B were treated with closed reduction and external fixation;type C were treated with open reduction and fixation with Kirschner wire,and then fixed with external fixator.The results were evaluated.Results 31 cases were followed up for 6～23（16±7） months postoperatively.26 cases got excellent reduction of articular surface,3 good and 2 poor;27cases had excellent limb alignment,3 good and 1 poor.According to Phillips Shwart ankle joint scoring system,the final results were scored to 78 to 92（average 85±0.3）.Conclusions According to different fracture type,using unilateral external fixator combined with choosing the right method to fix fibular fracture,it can avoid wound complications,with advantage of restoring anatomical articular surface and firm fixation,and can achieve good result.