闭合复位髓内钉固定胫骨骨折术中远端是否存在内外翻的判断

Determining distal tibial valgus or varus during treatment of distal tibial farctures with intramedullary nails

目的探讨闭合复位髓内钉内固定治疗胫骨骨折术中判断胫骨远端是否存在内外翻的方法。方法回顾性分析2014年1月至2015年1月采用闭合复位髓内钉内固定治疗的27例胫骨骨折患者资料，男19例，女8例；年龄22～76岁，平均44．6岁。术前对患者进行正、侧位x线片检查，术中在标准进钉点插入胫骨髓内钉后，利用远端水平位交锁钉与踝关节面在前后位X线片上的夹角判断骨折远端是否存在内外翻。结果27例患者术后获12～24个月（平均18．3个月）随访。骨折愈合时间为3．2～6．7个月（平均4．5个月）。术中测量27例患者，其中19例正常，6例发生外翻，2例发生内翻，发生内、外翻患者在术中均得到矫正。术后2d健侧胫骨远端外侧角为87．4°-89．2°（平均88．3°±0．9°），患侧胫骨远端外侧角为87．6°-90．2°（平均88．9°±1．3°），健侧与患侧间比较差异无统计学意义（P〉0．05）。术后12个月美国足踝外科协会踝一后足评分：优18例，良6例，一般2例，差1例，优良率为88．9％。结论闭合复位髓内钉内固定胫骨骨折术中，在标准进钉点插入胫骨髓内钉后，利用远端水平位交锁钉与踝关节面在前后位x线片上的夹角能够很好地判断骨折远端是否存在内外翻，并在术中及时处理。

Objective To explore how to determine distal tibial valgus or varus during treatment of distal tibial fractures with intramedullary nails. Methods Between January 2014 and January 2015, 27 distal tibia fractures were surgically treated with intramedullary nails at our department. They were 19 men and 8 women, aged from 22 to 76 years （average, 44.6 years）. Anteroposterior and lateral radiographs were taken in the course of preoperative radiological evaluation. To determine distal tihial valgus or varus, the parallel relationship between the distal horizontal interlocking nail and the ankle joint was examined in the antero- posterior X-ray films. Results The 27 patients were followed up for 12 to 24 months （average, 18.3 months） . The fractures healed after 3.2 to 6.7 months（average, 4.5 months） . The intraoperative mea- surement found 19 normal cases, 6 cases of valgus and 2 cases of varus. The abnormal cases were all corrected accordingly. At 2 days after surgery, the lateral angle of the distal tibia ranged from 87.4° to 89.2° （average, 88.3° ±0.9°） at the normal side, from 87.6° to 90.2° （average, 88.9° ± 1.3°） at the affected side, showing no significant difference （P〉 0.05） . According to the AOFAS ankle-hindfoot score at 12 months post-surgery, 18 cases were excellent, 6 good, 2 fair, and one poor, giving an excellent to good rate of 88.9%. Conclusions The distal tibial valgus or varus can be determined during operation using the angle between the distal horizontal interlocking nail and the ankle joint in anteroposterior X-ray films. This effective technique can lead to timely treatment of the distal tibial valgus or varus.