跟骨前突置钉外固定架结合有限切开内固定治疗胫骨远端粉碎性骨折的效果

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摘要目的探讨跟骨前突置钉外固定架结合有限切开内固定治疗胫骨远端粉碎性骨折的临床效果。方法回顾分析2014年1月～2016年1月因闭合性胫骨远端粉碎骨折在河北省沧州市中心医院骨科接受外固定架结合有限切开螺钉内固定治疗的19例患者临床资料。术中于跟骨后内侧及载距突前侧约1 cm置入骨折远侧端外固定钉，于踝前内侧做有限切口，解剖复位胫骨远端关节面骨折后,采用螺钉固定。手术4周后每周1次放松外架，锻炼踝关节屈伸活动。通过分析围术期数据及随访资料，评价患者术后的临床效果。结果平均手术时间（58.6±15.4）min，平均术中出血量（201.5±78.6）mL，平均住院时间（14.2±2.8）d。2例（10.5%）术后发生腓骨切口周围浅表炎性反应，1例（5.3%）术后并发外固定钉道感染，经处理后均愈合良好。所有患者无神经、血管损伤并发症出现。围术期总体并发症发生率为15.8%。病例获得13～15个月随访。所有病例骨折均获得愈合，未见复位丢失情况。在术后各随访时间点Lowa踝关节评分、视觉模拟量化疼痛评分比较，差异无统计学意义（P ＞ 0.05）。根据Maryland评分，总体优良率为84.2%。结论跟骨前突置钉外固定架结合有限切开内固定治疗胫骨远端粉碎性骨折临床效果良好，固定可靠，并发症发生率低，是一种可供选择的手术治疗方法。

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	张海森1 刘畅1 梁东启2 王怀良3 裴宝静3 刘辉4 刘颖5

关键词 ：跟骨前突, 外固定架, 有限切开复位内固定术, 胫骨远端骨折

Abstract：Objective To investigate clinical effect of external fixator pinning in anterior process of calcaneus combined with mini-open reduction and internal fixation in treatment of distal tibia comminuted fracture. Methods The clinical data of 19 patients with closed distal tibial comminuted fracture who received external fixator pinning in anterior process of calcaneus combined with mini-open reduction and internal fixation in the Derpatment of Orthopedics, Cangzhou Central Hospital in Hebei Province from January 2014 to January 2016 were retrospectively analyzed. During the operation, external fixation screws of the distal end of the fractures were placed in medial posterior side of the calcaneus and about 1 cm of sustentaculum of talus of calcaneus. A limited incision was made in the anterior medial side of the ankle, and screw fixation was adopted after the anatomical reduction of the distal articular surface fracture of the tibia. External fixator was relaxed for 1 time per week after postoperative 4 weeks in order to exercise motion of ankle. The perioperative data and follow-up data were analyzed to evaluate the postoperative clinical effect. Results The mean operation time was (58.6±15.4) min, the average intraoperative blood loss was (201.5±78.6) mL, and the average hospitalization time was (14.2±2.8) d. Two cases (10.5%) had postoperative superficial inflammatory reaction around fibular incision, and one case (5.3%) had postoperative infection of external fixation screw track, which healed well after treatment. No neurological or vascular injury complications occurred in all patients. The incidence of perioperative complications was 15.8%. The patients were followed up for 13 to 15 months. All fractures were healed without loss of reduction. There was no statistically significant difference between the Lowa ankle score and the visual analogue scale pain score at each postoperative follow-up time point (P ＞ 0.05). According to the Maryland score, the good rate of the curative effect was 84.2%. Conclusion External fixator pinning in anterior process of calcaneus combined with mini-open reduction and internal fixation in treatment of distal tibia comminuted fracture has good clinical effect, reliable fixation and low complication rate, which is an alternative surgical treatment method.

Key words： Anterior process of calcaneus External fixator Mini-open reduction and internal fixation Distal tibia fracture

基金资助:河北省沧州市科技计划项目（141302079）。

通讯作者: 刘畅（1977-），男，博士，副主任医师；研究方向：运动医学、骨关节外科。

作者简介: 张海森（1981-），男，硕士；研究方向：骨关节外科、运动医学。

引用本文:

张海森1 刘畅1 梁东启2 王怀良3 裴宝静3 刘辉4 刘颖5. 跟骨前突置钉外固定架结合有限切开内固定治疗胫骨远端粉碎性骨折的效果[J]. 中国医药导报, 2020, 17(12): 89-92.
ZHANG Haisen1 LIU Chang1 LIANG Dongqi2 WANG Huailiang3 PEI Baojing3 LIU Hui4 LIU Ying5. Effect of external fixator pinning in anterior process of calcaneus combined with mini-open reduction and internal fixation in treatment of distal tibia comminuted fracture. 中国医药导报, 2020, 17(12): 89-92.

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