腓骨切开复位内固定与胫骨闭合复位外支架固定治疗胫腓骨下段粉碎性骨折

Minimally invasive treatment of fractures of distal one-third of tibia-fibular

目的探讨对胫腓骨下段粉碎性骨折微创治疗方法的效果。方法胫腓骨下段粉碎性骨折36例,男21例,女15例;年龄12～65岁,平均38.5岁。其中闭合性骨折24例,Ⅰ度开放性骨折10例,Ⅱ度开放性骨折2例。采用单侧外固定支架与钢板螺丝钉结合微创治疗胫腓骨下段骨折。结果本组均获6个月～1年随访,平均9个月。定期X线复查,X线片示腓骨均解剖愈合,胫骨均功能位愈合,骨折临床愈合时间平均6个月。无软组织感染和骨髓炎发生。膝关节活动度大于90°,踝关节活动度15°～30°间,并达到骨愈合标准后拆除外固定架。去固定时间12～32周,平均24周,拆除固定后无再骨折发生。结论对于复杂粉碎性胫腓骨下段骨折的治疗,腓骨切开复位内固定与胫骨闭合复位外支架固定,操作简单、固定可靠、手术创伤小、符合微创术式原则。这为胫腓骨下段粉碎性骨折的治疗提供了有效的治疗方法,值得进一步的推广。

Objective To observe the clinical effect of minimally invasive treatment of comminuted fractures of distal one-third of tibia-fibular.Methods 36 patients with fractures of distal one-third of tibia-fibular,24 patients were closed.10 patients were I-degree open fracture,2 patients were II-degree open fracture.21 males,15 females,with a mean age of 38.5 years（range12～65）.The fractures were fixed by steel plates combined with unilateral external fixing frame.Results All patients were followed up 6 to 12 months（average 9 months） and acquired the bone was union.The mean time of bone union was 6 months.None of the patients had soft tissues infection and osteomyelitis.The range of motion in the knee was above 90° The range of motion in the ankle was 15°～30°the frame was removed after bone union,the mean frame time was 24 weeks（12～32weeks）.Conclusion Providing reliable reposion and fixation,internal fixation of fibula plus external fram fixtion of tibia is an excellent approach to the treatment of comminuted fractures of distal one-third of tibia-fibular,it is easy to performed with less wound,and is in conformity with the principle of minimally invasive treatment.