半伸直位髓内钉合空心螺钉固定治疗胫骨下1/3螺旋形骨折合并后踝骨折的疗效研究

Study on the Efficacy of Semiextended Positioning Intramedullary Nailing Combined with Hollow Screw Fixation in the Treatment of Spiral Fracture of the Distal Third of the Tibia Combined with Posterior Ankle Fracture

目的:探讨半伸直位髓内钉联合空心螺钉固定治疗胫骨下1/3螺旋形骨折合并后踝骨折的疗效。方法:回顾性分析2016年10月至2020年6月期间中国人民解放军陆军第七十三集团军医院收治的60例胫骨下1/3螺旋形骨折合并后踝骨折患者的临床资料,男47例,女13例,年龄18~71岁,平均(53.15±4.06)岁,致伤原因:车祸伤27例,摔伤21例,运动伤12例。根据髓内钉置钉方式不同将其分为两组,半伸直组采用半伸直位髓内钉联合空心螺钉固定(30例),标准组采用标准髓内钉联合空心螺钉固定(30例),所有患者术后随访1年。比较两组手术时间、术中出血量、骨折愈合时间、踝关节功能、膝关节功能、疼痛程度、并发症的差异。结果:半伸直组手术时间短于标准组(P<0.05),两组术中出血量、骨折愈合时间比较无统计学差异(P>0.05)。两组术后美国足踝外科协会(AOFAS)评分、Karlsson踝关节功能(KAFS)评分、美国纽约特种外科医院(HSS)评分均呈增高趋势(P<0.05),视觉模拟评分法(VAS)评分均呈降低趋势(P<0.05),半伸直组术后12周、术后1年VAS评分均低于标准组(P<0.05),HSS评分高于标准组(P<0.05)。两组并发症发生率比较无统计学差异(P>0.05)。结论:采用半伸直位髓内钉联合空心螺钉固定治疗胫骨下1/3螺旋形骨折合并后踝骨折患者,与标准髓内钉联合空心螺钉固定比较,安全性和促进踝关节恢复的效果相当,且手术用时更短,患者术后疼痛更轻,膝关节功能改善更明显,在治疗中更具优势。

Objective:To investigate the efficacy of semiextended positioning intramedullary nailing combined with hollow screw fixation in the treatment of spiral fracture of the distal third of the tibia combined with posterior ankle fracture.Methods:The clinical data of 60 patients with spiral fracture of the distal third of the tibia combined with posterior ankle fracture admitted to the 73rd Group Military Mospital of People’s Liberation Army Ground Force from October 2016 to June 2020 was analyzed retrospectively,including 47males and 13 females,aged 18 ~ 71 years old,with an average age of(53.15±4.06) years old.Causes of injury:traffic accident injuries with 27 cases,fall with 21 cases,and sports injury with 12 cases.According to the different methods of intramedullary nailing,the patients were divided into two groups,the semiextended group was fixed with semiextended positioning intramedullary nailing combined with hollow screw fixation(30 cases),and the standard group was fixed with standard intramedullary nailing combined with hollow screw fixation(30 cases).All patients were followed up for 1 year after surgery.The operative time,intraoperative blood loss,fracture healing time,ankle function,knee function,pain degree and complications were compared between the two groups.Results:The operative time in the semiextended group was shorter than that in the standard group(P0.05).After surgery,the American Association of foot and ankle surgery(AOFAS) score,Karlsson ankle function(KAFS) score and Hospital for Special Surgery(HSS) score in both groups increased gradually(P0.05).Conclusion:The patients with spiral fracture of the distal third of the tibia combined with posterior ankle fracture are treated with semiextended positioning intramedullary nailing combined with hollow screw fixation,compared with the standard intramedullary nailing combined with hollow screw fixation,the safety and effect of promoting ankle joint recovery are equivalent,and the operation time is shorter,the postoperative pain is lighter,the improvement of knee function was more obvious and has more advantages in the treatment.