摘要
目的探讨A型不同胫骨干骨折的手术疗效及合并踝关节骨折的发生率。方法将2012年10月-2016年10月于本院骨科就诊的189例胫骨干A型骨折患者根据骨折线的形态进行分组,A组(70例)胫骨螺旋形骨折,B组(58例)胫骨斜形骨折,C组(61例)胫骨干横形骨折;均行闭合复位、胫骨髓内钉内固定术,对三组的手术时间、平均住院时间、临床疗效、合并踝关节骨折发生率及X线漏诊率进行比较。结果所有患者于术后6周、3个月、12个月进行随访,在性别、年龄方面三组患者无统计学差异(P均>0.05)。其中A组38.6%合并踝关节损伤(骨折19例,下胫腓联合损伤8例);B组10.3%合并踝关节骨折;C组13.1%合并踝关节骨折;A组踝关节损伤概率明显大于其他两组(P均<0.05)。踝关节骨折X线漏诊方面,A组12例,B组1例,C组2例。平均住院时间A组(18.63±3.39)d,高于B组(15.26±2.71)d,C组(14.40±3.52)d,差异有统计学意义。手术时间A组(78.93±12.46)min,高于B组(66.43±15.09)min和C组(64.76±10.37)min,差异有统计学意义。术后12个月Johner-Wruhs疗效评估,A组优良率92.8%,B组优良率93.1%,C组优良率93.4%,三组差异无统计学意义(P>0.05)。结论 A型不同胫骨干骨折的术后疗效较好。胫骨螺旋形骨折由于特殊的暴力受伤机制,容易合并踝关节损伤,骨折类型以隐匿性骨折为主,漏诊概率大。
Objective To study surgical outcomes of A-type tibial shaft fracture and incidences of combined ankle injury. Methods Clinical data about 189 patients with A-type tibial shaft fracture admitted to our hospital from October 2012 to October 2016 were retrospectively analyzed. Patients were divided into three groups according to the morphology of fracture line, group A with spiral fracture（n=70）, group B with oblique fracture（n=58） and group C with transverse fracture（n=61）. All patients had undergone closed reduction and intramedullary nailing. The operating time, average length of hospital stay, surgical outcome, incidence of combined ankle injury and misdiagnosis by X-ray in three groups were analyzed and compared. Results All patients were followed up at 6 weeks, 3 months, 12 months after operation. There was no significant difference in gender and age between three groups（all P 〈0.05）. The incidence of ankle injury in A-type tibial shaft fracture was 38.6% in group A（12 cases of posterior malleolar fracture, 8 cases of distal tibiofibular syndesmosis injury, 4 cases of medial malleolar fracture and 3 cases of laternal malleolar fracture）, 10.3% in group B（3 cases of medial malleolar fracture and 3 cases of laternal malleolar fracture）, and 13.1% in group C（4 cases of medial malleolar fracture, 3 cases of laternal malleolar fracture and 1 case of posterior malleolar fracture）. The number of patients with ankle injury in group A was significantly more than the other two groups（all P 〈0.05）. The number of patients with ankle injury misdiagnosed by X-ray in group A was 12, 1 in group B and 2 in group C, and the difference between three groups was significant（all P 〈0.05）. And the average length of hospital stay and operating time in group A were significantly greater than those in the other two groups [（18.63±3.39） d vs（15.26±2.71） d and（14.40±3.52） d;（78.93±12.46） min vs（66.43±15.09） min and（64.76±10.37） min; P 〈0.05, respectively]. Accordin
作者
安晓
李志锐
马睿
魏均强
韩涛
陶笙
AN Xiao;LI Zhirui;MA Rui;WEI Junqiang;HAN Tao;TAO Sheng(Hainan Branch of Chinese PLA General Hospital, Sanya 572013, Hainan Province, China)
出处
《解放军医学院学报》
CAS
2018年第5期397-399,414,共4页
Academic Journal of Chinese PLA Medical School
关键词
胫骨干骨折
踝关节损伤
髓内钉
螺旋形骨折
tibial shaft fracture
ankle injury
intramedullary nail
spiral fracture
