急诊微创内侧锁定接骨板治疗胫骨远段骨折

Emergency treatment of distal segement tibial fractures with minimally invasive medial locking plate

目的 总结急诊微创内侧锁定接骨板治疗胫骨远段骨折的疗效。方法 采用急诊微创内侧锁定接骨板治疗26例胫骨远段骨折患者。记录术后并发症及功能恢复情况,末次随访时采用AOFAS踝-后足评分标准评价疗效。结果 患者均获得随访,时间10~36个月。术后2例切口边缘张力性表皮坏死,经换药处理后愈合;其余切口均一期愈合。骨痂开始形成时间8~12周,骨折愈合时间12~20周。无感染、骨折畸形愈合、螺钉松动、接骨板断裂等并发症发生。末次随访时,患者均能正常负重行走,24例患者踝关节背伸20°~30°、跖屈40°~45°,2例AO/ASIF分型B1型骨折患者踝关节背伸15°~20°、跖屈25°~35°;采用AOFAS踝-后足评分系统评价疗效:优20例,良4例,可2例,优良率为24/26。结论 急诊微创内侧锁定接骨板治疗胫骨远段骨折,具有治疗及时、操作简单、骨折固定牢靠、患者能早期功能锻炼的优点。

Objective To summarize the efficacy of emergency minimally invasive medial locking plate in the treatment of distal segement tibial fracture.Methods The 26 patients with distal segement tibial fractures were treated by emergency minimally invasive medial locking plate.Postoperative complications and functional recovery were recorded,and the efficacy was evaluated by AOFAS ankle-hindfoot score at the last follow-up.Results All patients were followed up for 10~36 months.After surgery,2 cases of wound edge tension epidermal necrosis healed after dressing change.All the other incisions healed in one-stage.The time of callus formation was 8~12 weeks,and the time of fracture union was 12~20 weeks.No infection,deformity healing after fracture,screw loosening and fracture of bone plate occurred.At the last follow-up,all patients could walk with weight-bearing normally.In 24 cases,the ankle dorsiflexion was 20°~30°and plantar flexion was 40°~45°;in 2 cases of B1-type fractures of AO/ASIF classification,the ankle dorsiflexion was 15°~20°and plantar flexion was 25°~35°.AOFAS ankle-hind foot scoring system was used to evaluate the curative effect:excellent in 20 cases,good in 4,fair 2 cases,the excellent and good rate was 24/26.Conclusions The emergency treatment of distal segement fracture with minimally invasive medial medial locking plate has the advantages of timely treatment,simple operation,reliable fracture fixation and early functional exercise.