带锁腓骨髓内钉治疗老年糖尿病外踝骨折患者的临床疗效分析

Clinical efficacy of locked fibular nail for the treatment of lateral malleolus fractures in elderly patients with diabetes

目的 :探讨带锁腓骨髓内钉固定对老年糖尿病患者合并外踝骨折的临床疗效。方法 :回顾性分析2012年7月至2014年7月手术治疗的22例老年糖尿病外踝骨折的患者的临床资料,其中男7例,女15例,年龄62~84(69.3±13.7)岁。根据Danis-Weber分型:A型2例,B型13例,C型5例,其他2例。均采用经微创入路带锁腓骨髓内钉(Acumed带锁腓骨髓内钉)固定治疗外踝骨折,记录术后并发症(切口并发症、复位丢失、内固定不适)和骨折愈合时间,并予术后1年采用美国足踝外科协会AOFAS踝与后足功能评分评价临床疗效。结果:21例患者获术后随访,时间12~24(17.3±5.9)个月。患者术后外踝切口均Ⅰ期愈合。无切口感染或坏死、血管神经及腓骨肌腱损伤发生。未发生复位丢失或内固定不适,所有外踝骨折获得愈合,时间8~14(10.3±3.9)周。术后1年随访时,AOFAS评分为87.4±5.2,其中优9例,良12例。结论:对于外踝骨折的老年糖尿病患者,带锁腓骨髓内钉可以有效复位并固定骨折,骨愈合率高,愈合时间短,并发症少,临床疗效满意。

Objective： To explore clinical outcome of locked fibular nail in treating lateral malleolus fractures in elderly patients with diabetes.Methods： From July 2012 to July 2014,clinical data of 22 diabetic patients with lateral malleolus fractures were respectively analyzed,including 15 females and 7 males,aged from 62 to 84 years old with an average of （69.3±13.7） years old. According to Danis-Weber classification,2 cases were type A,13 cases were type B,5 cases were type C,and 2 cases were other type. All patients were reduced and fixed with Acumed locked fibular nail through a minimally invasive approach. Complication and fracture healing was recorded after operation. Clinical function was evaluated according to AOFAS. Results： All patients were followed up from 12 to 24 months with an average of （17.3±5.9） months. All incisions were healed at stage I. No wound complication,neurovascular or tendon injuries occurred. No fixation loss or discomfort of nail was reported. All patients achieved primary bone union,and healing time ranged from 8 to 14 weeks with an average of （10.3±3.9） weeks. AOFAS score was 87.4±5.2 at 1 year after operation 9 cases got excellent results and 12 cases good. Conclusion： For elderly diabetic patients with lateral malleolus fractures,locked fibular nail has advantages of effective and stable fixation,high rate of bone healing,short healing time,less complication,and could obtain satisfied clinical effect.