双钢板内固定治疗腓骨远端粉碎性骨折

DUAL PLATING FIXATION FOR DISTAL FIBULAR COMMINUTED FRACTURES

目的评价双钢板内固定术治疗腓骨远端粉碎性骨折的方法及临床疗效。 方法2010年11月－2011年11月，采用切开复位腓骨远端双钢板内固定术治疗16例腓骨远端粉碎性骨折患者。其中男10例，女6例；年龄35～65岁，平均49.8岁。致伤原因：扭伤9例，交通事故伤5例，摔伤2例。均为闭合损伤，受伤至入院时间1～48 h，平均8 h。术前行踝关节正侧位X线片及CT三维扫描检查以明确损伤类型及受累范围。根据Weber分型，A型11例，B型5例；合并内踝骨折的双踝骨折5例，合并内、后踝骨折的三踝骨折2例。术后定期摄X线片明确骨折愈合情况，末次随访时采用美国矫形足踝协会（AOFAS）踝与后足评分和疼痛视觉模拟评分（VAS）评估疗效，同时记录踝关节伸屈活动度及相关并发症发生情况。结果术后1例糖尿病患者切口延期愈合，经换药后治愈；其余患者切口均Ⅰ期愈合。12例获随访，随访时间12～24个月，平均18个月。X线片示术后10～14周骨折端愈合，平均12周。随访期间未见内固定失败、畸形愈合、骨不连、创伤性关节炎等并发症发生。末次随访时AOFAS踝与后足评分为（79.6 ± 6.5）分，VAS评分为（1.3 ± 1.5）分，踝关节跖屈活动度为（70.0 ± 8.0）°，背伸活动度为（84.0 ± 5.1）°。 结论采用双钢板内固定术治疗腓骨远端粉碎性骨折可获得坚强稳定的固定，并发症发生率低，是一种安全可靠的治疗方法。

Objective To evaluate the technique and effectiveness of dual plating fixation for distal fibular comminuted fractures. Methods Between November 2010 and November 2011, 16 patients with distal fibular comminuted fractures were treated, including 10 males and 6 females with an average age of 49.8 years （range, 35-65 years）. All the patients had closed injury, which was caused by sprain in 9 cases, by traffic accident in 5 cases, and by falling in 2 cases. The average interval from injury to admission was 8 hours （range, 1-48 hours）. Routine X-ray and CT scan were taken for confirmation of classification and involvement. According to Weber classification system, 11 cases were rated as type A, and 5 as type B; 5 cases had bimalleolar fractures with medial malleolar fracture, and 2 cases had trimalleolar fractures with posterior and medial malleolar fracture. Open reduction and dual plating fixation were performed after swelling was subsided. The X-ray films were taken during follow-up. The effectiveness was evaluated with visual analogue scale （VAS） and American Orthopaedic Foot and Ankle Society （AOFAS） hindfoot and ankle score system at last follow-up. The range of motion （ROM） of the ankle and complications were also been recorded. Results Delayed healing of incision occurred in 1 patient with diabetes, who was cured after changing dressing; primary healing was obtained in the other patients. Twelve patients were followed up 18 months on average （range, 12-24 months）. Radiographic examination demonstrated the mean time of bone healing was 12 weeks （range, 10-14 weeks）. No complication of implant failure, malunion, nonunion, or post-traumatic arthritis occurred during follow-up. The AOFAS hindfoot and ankle score was 79.6 ± 6.5, and the VAS score was 1.3 ± 1.5. The ROM of the ankle was （70.0 ± 8.0）° of flexion and （84.0 ± 5.1）° of extension. Conclusion Dual plating fixation for distal fibular comminuted fractures can obtain a rigid stabilization with a low complication incidence, so it is a safe and effective method.