后内侧入路治疗胫骨远端骨折伴前方软组织损伤

Posteromedial approach for the treatment of distal tibial fractures accompanying with anterior soft tissue injury

目的:探讨后内侧入路治疗胫骨远端骨折伴前方软组织损伤的疗效。方法:2008年8月至2010年8月,采用小腿后内侧入路对31例胫骨远端粉碎性骨折患者进行切开复位内固定,其中男21例,女10例;年龄24～68岁,平均46岁。14例为开放性骨折,按照Gustilo-Anderson分型:Ⅰ型5例,Ⅱ型5例,ⅢA型2例,ⅢB型2例;17例为闭合性骨折,按照Tcherne-Oestern分型:Ⅰ型3例,Ⅱ型12例,Ⅲ型2例。根据AO分型,属于43A型(26例)及43C1型(5例)。观察项目包括手术时间、术中出血量、骨折愈合时间、AOFAS(AmericanOrthopaedicFootandAnkleSociety)踝关节评分及术后并发症。结果:31例患者均获随访,时间12～36个月,平均21个月。平均手术时间70min(40～110min)。平均出血量为100ml(50～200ml)。术后闭合性骨折平均愈合时间为13周(10～18周),开放性骨折平均愈合时间为19周(15～29周)。末次随访时X线片示:1例出现4°足内翻,1例出现3°足外翻。末次随访AOFAS评分为69～100分,平均(88.4±9.7)分。其中优10例,良17例,中4例。结论:对伴有局部内外侧软组织损伤或皮肤条件较差的胫骨远端骨折患者,后内侧入路固定疗效满意。

Objective：To investigate the clinical results of distal tibia fractures accompanying with anterior soft tissue in- jury by posteromedial approach. Methods：From August 2008 to August 2010,31 patients （21 males and 10 females, ranged in age from 24 to 68 years with an average of 46 years） with distal tibia fractures accompanying with anterior soft tissue injury were treated with open reduction and internal fixation through posteromedial approach. Of the 31 cases, 14 cases were open fractures （including 5 cases Gustilo-Anderson type Ⅰ ,5 type Ⅱ ,2 typemA ,and 2 type ⅢB） and 17 cases were closed frac- tures （ including 3 cases Tcherne-Oestern type Ⅰ , 12 type Ⅱ , 2 type Ⅲ）. According to typing of AO, type 43A were in 26 eases and type 43C 1 were in 5 cases. Operation time, intraoperative blood loss, fracture healing time, AOFAS ankle score, and com- plications were recorded to evaluate clinical effects. Results ：All the patients were followed up from 12 to 36 months with an average of 21 months. The mean operation time was 70 min （ranged,40 to 110 rain） and the mean blood loss was 100 ml （ranged ,50 to 200 ml）. Average healing time for closed fractures was 13 weeks （ranged, 10 to 18 weeks） ,while open fractures was 19 weeks （ranged,15 to 29 weeks）. Cross-foot of 4° occurred in 1 case and pes valgus of 3° in 1 case at final follow-up; and AOFAS ankle scores were from 69 to 100 with an average of 88.4±9.7. Of them, 10 cases obtained excellent results, 17 good, 4 fair. Conclusion： Postermedial approach is an effective method for distal tibia fractures especially accompanying with local soft tissue injury or bad skin condition.