摘要
目的：探讨胫骨下段螺旋型骨折伴后踝骨折的漏诊原因、损伤机制及治疗策略。方法手术治疗81例胫骨下段螺旋型骨折合并后踝骨折患者,X线检查发现后踝骨折38例,其余通过CT检查发现。后踝骨折用？4．5 mm空心钉固定,以防胫骨骨折髓内钉固定过程中再移位,胫骨在足外旋位牵引下采用交锁髓内钉固定,下段腓骨骨折采用钢板或克氏针固定,上段腓骨骨折未固定。结果81例患者均获得随访,时间4~11个月。68例后踝经皮空心钉内固定,骨折均获骨性愈合；13例因骨折块小和移位不明显未予固定。79例骨折均骨性愈合,2例因断端间隙过大发生骨不连,经植骨后愈合。1例因后踝骨折移位发生踝关节创伤性关节炎。伤口无感染及骨髓炎发生。最终功能评定采用Joher-Wruhs标准：优67例,良10例,中3例,差1例,优良率95%。结论胫骨下段螺旋型骨折常合并隐匿的后踝骨折,单纯X线检查易漏诊,CT检查可明确诊断。损伤机制为旋后（足）-内旋（胫骨）引起。后踝骨折超过胫骨远端关节面10%者可行经皮？4．5 mm空心钉内固定治疗；下段腓骨骨折采用钢板或克氏针固定,上段腓骨骨折可不固定；胫骨骨折在足外旋牵引复位下行髓内钉固定可获得优良效果。
Objective To explore the cause of leak diagnosis, injury mechanism and treatment strategy of the distal 1/3 spiral tibial shaft fracture associated with occult posterior malleolar fracture. Methods 81 patients with distal third spiral tibia shaft fracture associated posterior malleolar fractures were treated by surgery. The radiology detected 38 posterior malleolar fracture. The rest fractures were determined by CT scan. All cases were fixed with tibial intr-amedulary nailing at the supination foot and the internal-rotation tibia. The posterior malleolar fractures were fixed with ？ 4. 5 mm cannulated screws. All cases of distal 1/2 fibular fractures were fixed with plates or Kirschner wires. All of proximal fibular fractures were not fixed. Results 81 cases were all followed up from 4 months to 11 months. 68 cases of posterior malleolar fractures were fixed with cannulated screws, which can prevent displacement during in-tramedullary nailing of tibia shaft fractures, and all showed radiographic evidence of healing. 13 cases were not fixed for small and no displacement fractures. 79 cases of spiral tibial shaft fracture were healed according to plain radio-graphs standard. 2 cases were ununion for excessive gap between fractures and later healed with bone grafting. 1 case occurred ankle traumatic arthritis. The wounds were not contaminated and no osteomyelitis occurred. According to Johner-Wruhs evaluation standard, the results were excellent in 67 cases, good in 10, fair in 3 and poor in 1;the ex-cellent and good rate was 95%. Conclusions Distal spiral tibia shaft fractures are associated with ipsilateral posteri-or malleolar fractures, which plain radiographs are often insufficient for detecting. Using a preoperative CT protocol for spiral tibial shaft fractures can significantly improve the ability to diagnose associated posterior malleolar fractures that may not be evident on plain radiographs. Injury mechanism is the supination foot and the internal-rotation tibia. The posterior malleolar fractures are fixe
出处
《临床骨科杂志》
2015年第5期615-618,共4页
Journal of Clinical Orthopaedics
关键词
胫骨螺旋型骨折
后踝骨折
髓内钉
骨折固定术
内
spiral tibial fracture
posterior malleolar fracture
intramedulary nailing
fracture fixation,internal
