胫骨髓内钉联合空心钉内固定治疗胫骨干骨折合并后踝骨折

Treatment of tibial shaft fracture combined with posterior malleolar fracture with tibial intramedullary nail fixation combined with cannulated screw fixation

目的 探讨胫骨髓内钉联合空心钉内固定治疗胫骨干骨折合并后踝骨折的疗效。方法 采用胫骨髓内钉联合空心钉内固定治疗16例胫骨干骨折合并后踝骨折患者。记录骨折复位情况、骨折愈合时间、并发症发生情况。采用AOFAS踝-后足功能评分评价临床疗效。结果 患者均获得随访,时间13~53(30.20±11.94)个月。术后胫骨干及后踝骨折均对位对线良好;胫骨干骨折愈合时间2~3(2.45±0.36)个月;后踝骨折愈合时间1~2(1.49±0.36)个月。术后内固定稳定,无骨折块进一步移位、螺钉松动、创伤性关节炎等并发症发生。末次随访时,采用AOFAS踝-后足功能评分评价临床疗效:优8例,良7例,可1例,优良率15/16。结论 胫骨髓内钉联合空心钉内固定治疗胫骨干骨折合并后踝骨折临床疗效确切,术前应常规行CT或MRI检查以降低漏诊率,术中应尽量避免空心钉进入下胫腓联合而影响患者术后踝关节功能的恢复。

Objective To investigate the effect of tibial intramedullary nail fixation combined with cannulated screw fixation on tibial shaft fracture combined with posterior malleolar fracture.Methods The 16 patients with tibial shaft fractures combined with posterior malleolar fractures were treated by tibial intramedullary nails combined with cannulated screws.Fracture reduction,healing time and complications occurrence were recorded.The clinical effect was evaluated by AOFAS ankle-hindfoot function scores.Results All patients were followed up for 13~53(30.20±11.94)months.The alignment of tibial shaft and posterior malleolar fractures were good after operation.The healing time of tibial shaft fracture was 2~3(2.45±0.36)months.The healing time of posterior malleolar fracture was 1~2(1.49±0.36)months.The internal fixation was stable after operation,without further displacement of fracture mass,screw loosening,traumatic arthritis and other complications.At the last follow-up,the clinical effect was evaluated by AOFAS ankle-hindfoot function scores:excellent in 8 cases,good in 7 cases,fair in 1 case,the excellent-good rate was 15/16.Conclusions In the treatment of tibial shaft fracture combined with posterior malleolar fracture,the clinical efficacy of tibial intramedullary nail combined with cannulated screw fixation is accurate.Preoperative CT or MRI examination should be performed routinely to reduce the rate of missed diagnosis.During the operation,cannulated screw should be avoided to affect the recovery of ankle joint function.