跟骨前突置钉外固定架治疗AO/ASIF-43 A3型胫骨远端骨折的临床效果

Clinical effect of external fixator pinning in anterior process of calcaneus for treatment of AO/ASIF 43.Type A3 distal tibial fractures

目的考察AO/ASIF-43 A3型胫骨远端骨折采用跟骨前突置钉外固定架固定的临床疗效。方法选取2013年1月~2018年1月在河北省沧州市中心医院骨科采用跟骨前突置钉外固定架固定的AO/ASIF-43 A3型胫骨远端骨折患者36例,对其相关资料进行回顾性分析。所有病例均伴有腓骨远端骨干骨折,且胫腓骨远端骨折均为闭合性骨折。术中于跟骨后内侧及载距突前侧约1 cm置入骨折远侧端外固定钉,采用后外侧切口钢板内固定腓骨骨折。术后4周开始训练踝关节屈伸,每周放松外架1次。记录手术时间、术中出血量、骨折愈合时间以及围术期并发症等数据。对患者进行为期18个月术后随访,临床疗效的评价采用Maryland评分、Lowa踝关节评分和疼痛视觉模拟(VAS)评分。结果平均手术时间(42.6±23.8)min,平均术中出血量(149.5±28.6)mL,平均住院时间(9.2±2.9)d。术后出现腓骨切口浅表炎性反应1例(2.8%),外固定钉道感染1例(2.8%),经相应处理后均愈合。所有病例均未发生血管、神经损伤并发症,总体围术期并发症发生率为5.6%。所有病例均经术后18个月随访。所有病例均获得骨折愈合,无复位丢失出现。患者Lowa踝关节评分与VAS评分术后各时间点整体比较,差异无统计学意义(P>0.05)。基于Maryland评分的整体优良率为88.9%。结论跟骨前突置钉闭合复位外固定架技术在AO/ASIF-43 A3型胫骨远端骨折损伤早期是一种可供选择的治疗方法,该方法临床疗效良好,固定可靠,并发症发生率低。

Objective To investigate clinical effect of the external fixator pinning in anterior process of calcaneus for treatment of AO/ASIF 43.Type A3 distal tibia fracture.Methods Thirty-six patients of AO/ASIF 43.Type A3 distal tibia fracture fixed by external fixator pinning in anterior process of calcaneus in the Department of Orthopedics,Cangzhou Central Hospital,Hebei Province from January 2013 to January 2018 were selected,and the relevant data were retrospectively analyzed.All cases were associated with fracture of shaft of distal fibula,and all fractures of distal tibia and fibula were closed fractures.During the operation,the distal end of the fracture was fixed with an external pin about 1 cm in the posterior medial side of the calcaneus and the anterior side of the sustentaculum of talus of calcaneus,and internal fixation of fracture of shaft of distal fibula was fixed with a posterolateral incision plate.Ankle flexion and extension training began 4 weeks after the operation,and relaxed the external fixator once a week.The operative time,intraoperative blood loss,fracture healing time and perioperative complications were recorded.The patients were followed up for 18 months after the operation.The clinical efficacy was evaluated by Maryland score,Lowa ankle joint score,and visual analogue scale(VAS)score.Results The average operative time was(42.6±23.8)min,the average intraoperative blood loss was(149.5±28.6)mL,and the average length of stay was(9.2±2.9)d.After the operation,one patient(2.8%)had superficial inflammatory reaction of fibula incision and one case(2.8%)had infection of external pin hole,and all healed after corresponding treatment.No vascular and nerve injury complications occurred in all cases.The overall incidence rate of perioperative complications was 5.6%.All cases were followed up for 18 months after the operation.Fracture healing was achieved in all cases without reduction loss.There were no statistically significant differences between the overall Lowa ankle score and VAS score at each postoperative time point(P>0.05).According to the Maryland score,the good rate of the curative effect was 88.9%.Conclusion The closed reduction and external fixator pinning in anterior process of calcaneus is an alternative treatment method in the early stage of AO/ASIF 43.Type A3 distal tibia fracture injury,which has good clinical efficacy,reliable fixation and low complication rate.