螺旋形胫腓骨骨折合并后踝骨折治疗选择的回顾性分析

发布时间：2018-06-23 21:29

  本文选题：螺旋形胫腓骨骨折 + 后踝骨折　； 参考：《大连医科大学》2017年硕士论文

【摘要】：目的:螺旋形胫腓骨骨折在下肢长骨干骨折中经常发生,螺旋形胫腓骨骨折合并同侧后踝骨折近些年也越来越被大家熟知,然而对于所合并后踝骨折是否需要内固定、后踝骨折所占胫骨远端关节面多大比例时需要固定以及如何固定一直存在争议,不同的骨科医生都有不同的标准。本文的研究目的就是评估螺旋形胫腓骨骨折合并后踝骨折的治疗选择从而为这一类型骨折提供更好的治疗建议。方法:回顾性分析了 2013年1月-2016年11月大连医科大学附属第一医院创伤骨科收治的123例所有的胫腓骨骨折患者,其中螺旋形胫腓骨骨折(A0分型为42-A1、42-B1、42-C1)同时合并后踝骨折的病例共29例,其中有13例行后踝骨折内固定,有16例后踝骨折未行内固定但全部行术后石膏外固定,我们以既往文献中有争议的后踝骨折所占远端关节面25%比例为基准进行研究,分别将后踝骨折大于等于远端关节面25%病例以及小于25%病例进行单独分组,然后将后踝骨折是否进行内固定分为固定组与非固定组,通过手术时间、术后负重时间、AOFAS踝与后足评分及创伤后关节炎进行比较并做统计学分析,从而比较各组的临床疗效。结果:123例胫腓骨骨折的患者中共有29例(23.6%)为螺旋形胫腓骨骨折合并后踝骨折,其中9例(31.03%)后踝骨折≥25%胫骨远端关节面,20例(68.94%)后踝骨折25%胫骨远端关节面。在后踝骨折≥25%胫骨远端关节面的病例中,后踝骨折固定组共有4例(44.44%),非固定组有5例(55.56%),通过比较两组相关数据,在手术时间方面有统计学意义,后踝固定组大于后踝非固定组;在术后患肢负重时间方面有统计学差异,后踝固定组早于后踝非固定组;在AOFAS评分方面有统计学差异,固定组明显好于非固定组;两组均无创伤性骨性关节炎发生。在20例后踝骨折25%胫骨远端关节面的病例中,有9例(45.0%)后踝骨折被固定为固定组,有11例(55.0%)后踝骨折未被固定为非固定组,通过比较两组相关数据,在手术时间方面有统计学意义,后踝固定组大于后踝非固定组;在术后患肢负重时间方面有统计学意义,后踝固定组早于后踝非固定组;在AOFAS评分方面无统计学差异,且都大于90分,均令人满意,两组均无创伤性骨性关节炎发生。结论:在后踝骨折≥25%胫骨远端关节面的病例中,后踝固定组与后踝非固定组相比术后患肢负重时间更早、AOFAS评分更高,临床疗效更好,因此后踝骨折需行内固定手术。在后踝骨折25%胫骨远端关节面的病例中,后踝固定组与后踝非固定组相比虽然术后患肢负重时间更早,但是手术时间更长,AOFAS评分无明显差别(90分)均令人满意,临床疗效并无明显差别,且增加了患者的手术费用、给患者带来了更大的创伤,因此我们觉得后踝骨折无需内固定手术,石膏外固定治疗即可。
[Abstract]:Objective: spiral tibia and fibula fractures occur frequently in the long shaft fractures of the lower extremities. Spiral tibiofibula fractures with ipsilateral posterior malleolar fractures are more and more well known in recent years. The ratio of posterior ankle fracture to distal tibial articular surface is controversial, and different orthopedic doctors have different standards. The purpose of this study is to evaluate the treatment choice of helical tibiofibula fracture combined with posterior ankle fracture to provide better treatment advice for this type of fracture. Methods: 123 patients with tibia and fibula fractures treated in Department of Trauma and Orthopaedics, first affiliated Hospital of Dalian Medical University, from January 2013 to November 2016, were retrospectively analyzed. Among them, 29 cases of spiral tibiofibula fracture (A0 type 42-A1n42-B1F42-C1) were combined with posterior malleolar fracture. 13 cases were treated with posterior malleolar fracture internal fixation, 16 cases with posterior malleolar fracture without internal fixation but all cases were treated with plaster external fixation after operation. Based on the 25% ratio of posterior malleolar fracture to distal articular surface in previous literatures, we grouped 25% of cases with posterior malleolar fracture greater than 25% of distal articular surface and less than 25% of cases with less than 25% of posterior malleolar fracture. Then, the posterior ankle fracture was divided into fixed group and non-fixed group. Through the operation time, the weight bearing time and AOFAS ankle score and post-traumatic arthritis were compared and statistically analyzed, so as to compare the clinical efficacy of each group. Results among 123 cases of tibiofibula fracture, 29 cases (23.6%) were spiral tibiofibula fracture with posterior malleolar fracture, 9 cases (31.03%) had posterior ankle fracture 鈮，

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