1/3管型钢板在开放性胫骨远端骨折二期内固定辅助复位中的应用

Application of 1/3 tubular steel plate in secondary internal fixation and assisted reduction in open distal tibial fractures

目的探讨1/3管型钢板在开放性胫骨远端骨折二期内固定辅助复位中的应用效果。方法回顾性分析2019年9月至2021年8月在苏州瑞华骨科医院足踝外科进行手术治疗的6例开放性胫骨远端骨折患者资料,男5例,女1例。急诊行清创,腓骨采用钢板或髓内针固定,胫骨远端采用克氏针有限内固定结合外固定支架固定,修复血管神经及肌腱,根据创面情况采用皮瓣或植皮修复。伤口愈合及皮瓣或植皮存活后,取外固定支架更换为内固定。先用1/3管型钢板辅助复位固定,再用主力钢板确定性固定,取自体髂骨植骨,记录骨折愈合时间,根据美国足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)踝与后足功能评分评价下肢功能,统计并发症发生情况。结果6例患者行内固定术后,伤口均一期愈合,随访12~31个月(平均18个月),所有患者均获骨性愈合,骨折愈合时间3.5~8.0个月,平均5.5个月,随访期间未出现骨不连、再骨折及内固定失败等并发症。末次随访时根据AOFAS踝与后足功能评分判定优良率:优4例,良1例,可1例,优良率83.33%。结论1/3管型钢板在开放性胫骨远端骨折二期内固定中辅助复位具有容积小、增加稳定性等作用,疗效确切。

Objective To investigate the application of 1/3 tubular steel plate in secondary internal fixation and assisted reduction of open distal tibial fractures.Methods A retrospective analysis was done of 6 patients with open distal tibial fractures who underwent foot and ankle surgery at Suzhou Ruihua Orthopedic Hospital from September 2019 to August 2021.5 males and 1 female in this group.Emergency debridement was performed,fibula was fixed with steel plate or intramedullary nail,distal tibia was fixed with Kirschner wire limited internal fixation combined with external fixation bracket.Blood vessels,nerves,and tendons were repaired.According to the situation of the wound,skin flaps or skin grafts were chosen.When the wound heals and the flap or skin graft survives,the external fixing bracket was replaced with internal fixation.1/3 tubular steel plate was used to assist in reduction and fixation,and the main steel plate was used for definitive fixation.Autologous iliac bone grafts were taken for bone graft,and the time of fracture healing was recorded.The lower limb function was evaluated according to the American Orthopaedic Foot and Ankle Society(AOFAS)Ankle and hind Foot Scoring System and the occurrence of complications was recorded.Results 6 patients were primary healing after internal fixation.During a follow-up of 12 to 31 months(an average of 18 months),all patients achieved bone healing.The fracture healing time was 3.5 to 8.0 months,with an average of 5.5 months.During the follow-up period,there were no complications such as nonunion,refracture,and internal fixation failure.At the last follow-up,according to the ankle and hind foot scoring system of the AOFAS,4 cases were excellent,1 case was good,and 1 case was fair,with a good rate of 83.33%.Conclusion The application of 1/3 tubular steel plate in secondary internal fixation of open distal tibial fractures had the advantages of rapid,convenient,small volume,and enhanced internal fixation reliability.This method had a definite therapeutic effect.