胫骨下1/3螺旋形骨折合并隐匿性后踝骨折的治疗分析

Treatment of the Distal 1/3 Spiral Tibial Fracture Associated with Occult Posterior Malleolus Fracture

目的探讨胫骨下1/3螺旋形骨折合并隐匿性后踝骨折的发生原因、受伤机制和治疗方案。方法于2005年2月至2011年6月收治胫骨下1/3螺旋形骨折22例,其中有显性后踝骨折6例。采用胫骨髓内钉固定8例,胫骨下端前侧钢板1例,胫骨前外侧钢板13例;2例腓骨中段骨折采用重建钢板固定,其余腓骨均未固定。结果术中有4例患者在应用前外侧钢板固定最远端时发现隐匿性后踝骨折并移位,1例采用胫骨髓内钉的患者术后1个月复查X线片发现隐匿性后踝骨折伴移位。结论术前没有CT、MRI检查能够确诊后踝骨折类型和大小时,胫骨下端前外侧钢板可作为首选的内固定。

Objective To explore the cause and treatment of the distal 1/3 spiral tibial fracture associated with occult posterior malleolus fracture.Methods From February 2005 to June 2011,22 cases of distal 1/3 spiral tibial fracture were treated in our department.8 cases were fixed with tibial intramedullary nailing,1case was fixed with distal tibia anterolateral plate,13 cases were fixed with tibialis anterior lateral plate,2 cases with middle fibula fractures were fixed with reconstruction plate.Results 4 cases were found occult posterior malleolus fractures during the operation and fixed with anterolateral distal tibia plates.1 cases were found occult posterior malleolus fracture and fixed with tibial intramedullary nailing after a month.Conclusion If preoperative posterior malleolus fracture do not be confirmed,anterolateral distal tibia plates should be as the preferred internal fixation.