胫骨中下1/3螺旋形骨折合并后踝骨折69例诊疗体会

Diagnosis and Treatment of 69 Cases of Spiral Fracture of Middle and Lower 1/3 of Tibia Combined With Posterior Malleolus Fracture

目的探讨胫骨中下1/3螺旋形骨折合并后踝骨折的临床特点、诊断方法及治疗手段,提高骨科医师对此类型损伤的认识。方法回顾性分析2019年1月—2021年12月湖南医药学院第一附属医院创伤骨科收治的69例成人胫骨中下1/3螺旋形骨折合并后踝骨折患者的临床资料,按照后踝骨折块大小分为内固定组和石膏外固定组。胫骨骨折使用髓内钉或锁定钢板固定,后踝骨折内固定组使用空心螺钉固定,石膏外固定组使用石膏托固定。门诊随访记录骨折愈合及并发症发生情况,美国足与踝关节协会踝与后足功能评分(American orthopedic foot and ankle society,AOFAS)评价踝关节功能。结果胫骨中下1/3螺旋形骨折合并后踝骨折发生率为81.2%,X线检查漏诊率为55.1%,同时合并腓骨骨折58例(84.1%)。内固定组和石膏外固定组患者一般情况比较,差异无统计学意义(P>0.05)。所有患者均获得有效随访,随访时间超过12个月,术后未出现并发症。末次随访踝关节AOFAS评分,优59例,良8例,可2例,优良率为97.1%。结论胫骨中下1/3螺旋形骨折往往同时合并后踝骨折和腓骨骨折,CT是必要检查;后踝骨折根据损伤程度不同,采取石膏外固定或螺钉固定,但应避免漏诊,防止并发症。

Objective To explore the clinical features,diagnostic methods and treatment methods of spiral fracture of middleand lower 1/3 of tibia combined with posterior malleolusfracture,and raise awareness among orthopedic surgeons aboutthis injury. Methods A retrospective analysis was performedon sixty-nine adult patients who were admitted to The FirstAffiliated Hospital of Hu'nan University of Medicine fromJanuary 2019 to December 2021 for spiral fracture of middleand lower 1/3 of tibia combined with posterior malleolusfracture. The patients were divided into internal fixation groupand gypsum external fixation group according to different sizeof posterior malleolus fracture. The tibial fracture were treatedwith intramedullary nail or locking plate internal fixation in twogroups. Posterior malleolus fractures were fixed with hollowscrew in internal fixation group, and plaster slab was adoptedin gypsum external fixation group.The fracture healing timeand complications were recorded during outpatient follow-up.The AOFAS score was used to evaluate the ankle joint function.Results 81.2% of the patients with spiral fracture of middle andlower 1/3 of tibia had developed posterior malleolus fracture,the misdiagnosis rate of X-ray examination was 55.1%, besides58 patients developed fibular among the 69 cases (84.1%). Therewere no significant differences in general conditions betweeninternal fixation group and gypsum external fixation group (P >0.05). All patients received effective follow-up for more than 12months, and no postoperative complications. The AOFAS scorewas used at the last follow-up: 59 cases were excellent, 8 caseswere good, and fair in 2 cases, with excellent and good rate of97.1%. Conclusion The spiral fracture of middle and lower 1/3of tibia ofen combined with posterior malleolus fracture andfibular fracture. CT scan is a necessary examination.Posteriormalleolus fractures should be treated with plaster externalfixation or screw fixation according to different degree of injury.It is the most important to avoid missed diagnosis and preventcomplications.