三种手术方式治疗胫骨下1/3螺旋形骨折合并后踝骨折的疗效比较

Comparison of three surgical methods for lower 1/3 spiral fracture of the tibia combined with posterior malleolar fracture

目的比较髓内钉、单纯钢板、钢板+后前螺钉联合固定治疗胫骨下1/3螺旋形骨折合并后踝骨折的疗效。方法回顾性分析2015年6月至2022年6月青岛大学附属医院骨科收治的78例胫骨下1/3螺旋形骨折合并后踝骨折患者资料。男46例,女32例;年龄为(48.9±14.6)岁。根据固定方式不同分为3组:A组18例,胫骨端骨折采用髓内钉固定;B组40例,胫骨端骨折采用钢板固定;C组20例,胫骨端骨折采用钢板固定,后踝骨折采用后前螺钉固定。比较3组患者的手术时间、术中出血量、骨折愈合时间、术前及术后末次随访时美国足踝外科协会(AOFAS)踝-后足评分、Baird-Jackson评分、术后并发症发生情况。结果3组患者术前临床基线资料比较差异均无统计学意义(P>0.05),具有可比性。所有患者术后随访(24.9±10.1)个月。A组患者的骨折愈合时间14.0(13.0,14.0)周显著长于B、C组患者的13(13,14)周,差异均有统计学意义(P<0.05)。所有患者末次随访时AOFAS踝-后足评分、Baird-Jackson评分均显著优于术前,差异均有统计学意义(P<0.05)。B、C组患者的末次随访时AOFAS踝-后足评分[95.5(86.0,96.0)分,96.0(89.5,98.5)分]均显著高于A组患者[86.5(78.0,93.0)分],B、C组患者的末次随访时Baird-Jackson评分[93.0(88.8,95.0)分,95.0(91.0,98.0)分]均显著高于A组患者[86.0(78.0,89.5)分],差异均有统计学意义(P<0.05)。所有患者有7例发生并发症(骨折愈合不良3例、膝前痛4例),均为A组患者。结论与髓内钉固定治疗相比,钢板固定和钢板+后前螺钉联合固定治疗胫骨下1/3螺旋形骨折合并后踝骨折可以获得更好的疗效。

ObjectiveTo compare the therapeutic effects of intramedullary nail fixation,simple tibial plate fixation,and tibial plate+posterior-to-anterior screw fixation in the surgical treatment of lower 1/3 spiral fracture of the tibia combined with posterior malleolar fracture.MethodsA retrospective study was conducted to analyze the clinical data of 78 patients with lower 1/3 spiral fracture of the tibia combined with posterior malleolar fracture who had been treated at Department of Orthopedics,The Hospital Affiliated to Qingdao University from June 2015 to June 2022.There were 46 males and 32 females with an age of(48.9±14.6)years.The patients were divided into 3 groups according to their fixation methods.Group A(18 patients)underwent simple intramedullary nail fixation,group B(40 patients)simple tibial plate fixation,and group C(20 patients)tibial plate fixation for tibial fractures and posterior-to-anterior screw fixation for posterior malleolar fractures.The operation time,intraoperative blood loss,fracture union time,postoperative complications,as well as ankle-hindfoot scores of American Orthopaedic Foot and Ankle Society(AOFAS)and Baird-Jackson scores at pre-and post-operation were compared among the 3 groups.ResultsThe differences in the preoperative baseline data were not statistically significant among the 3 groups,indicating comparability(P>0.05).All patients were followed up for(24.9±10.1)months.The fracture union time in Group A was 14.0(13.0,14.0)weeks,significantly longer than that in groups B and C[13(13,14)weeks](P<0.05).The AOFAS ankle-hindfoot score and Baird-Jackson score at the last postoperative follow-up in all patients were better than those before surgery(P<0.05).The AOFAS ankle-hindfoot scores at the last follow-up in groups B and C[95.5(86.0,96.0)points and 96.0(89.5,98.5)points]were significantly higher than that in group A[86.5(78.0,93.0)points](P<0.05),and the Baird-Jackson scores at the last follow-up in groups B and C[93.0(88.8,95.0)points and 95.0(91.0,98.0)points]were also significantly higher than that in group A[86.0(78.0,89.5)points](P<0.05).All the 7 cases of complications(3 ones of poor fracture union and 4 ones of anterior knee pain)were observed in group A.ConclusionIn the surgical treatment of lower 1/3 spiral fracture of the tibia combined with posterior malleolar fracture,tibial plate fixation and tibial plate+posterior-to-anterior screw fixation can achieved better therapeutic effects than intramedullary nail fixation.