滑动撑开技术配合解剖钢板矫正腓骨短缩和旋转畸形

Dynamic distraction with distal fibular anatomical plate to correct fibular shortening and malrotation

[目的]介绍滑动撑开配合解剖钢板治疗腓骨短缩和旋转畸形的手术技术与初步临床疗效。[方法]2015年9月~2017年3月对17例踝部骨折术后腓骨畸形患者行手术矫正;从第一次手术至畸形愈合矫正时间平均(5.59±1.94)个月;术前常规行影像检查,对腓骨短缩和旋转畸形进行个体化评估,术中截骨后采用滑动撑开技术配合解剖钢板恢复腓骨长度和旋转。[结果]17例患者获得随访,平均随访(25.65±11.10)个月。所有患者均无感染,术后AOFAS评分、SF-36评分较术前显著提高,而VAS评分显著下降(P<005)。影像学显示术后骨折线愈合时间(11.88±1.32)周,且力线恢复良好。[结论]滑动撑开技术配合解剖钢板能很好地纠正腓骨长度和旋转畸形,恢复踝穴的匹配,改善踝关节功能,有助于延缓骨性关节炎的发生。

[Objective]To introduce surgical technique and primary clinical outcomes of dynamic distraction with distal fibular anatomical plate(DFAP)to correct fibular shortening and malrotation.[Methods]A total of 17 patients underwent surgical correction for fibular shortening and malrotation secondary to primary surgery for ankle fractures between 2015 and 2017 with average time elapsed between the primary and secondary operations of(5.59±1.94)months.Based on routine imaging examinations before the corrective operation,the shortening and malrotation deformities of the lateral malleolus were individually evaluated.During the corrective operation,the lateral malleolus restored to anatomical alignment with correction of shortening and malrotation by dynamic distraction with the distal fibular anatomic plate after distal fibular osteotomy.[Results]All 17 patients were followed up with an average time of(25.65±11.10)months after the secondary operation.No serious complications,such as infection,happened in anyone of them.The AOFAS and SF-36 scores significantly increased,whereas the VAS score significantly decreased after operation compared with those before operation(P<0.05).Regarding to radiographic assessment,all the patients got bony healing of the osteotomy sites in(11.88±1.32)weeks,with satisfied restoration of the lateral malleolus anatomic alignment.[Conclusion]The dynamic distraction with distal fibular anatomical plate is effective technique to correct fibular shortening and malrotation deformities subsequent to ankle fracture for reducing the pain and improving the function of the ankle joint.