Collinge Cory, Kuper Mark, Larson Kirk, Protzman Robert
Harris Methodist Fort Worth Hospital Orthopedic Trauma Staff, John Peter Smith Orthopedic Surgery Residency, Fort Worth, TX 76104, and Orthopedic Surgery, Texas Tech University, Lubbock, USA.
J Orthop Trauma. 2007 Jul;21(6):355-61. doi: 10.1097/BOT.0b013e3180ca83c7.
OBJECTIVE: The purpose of this study is to evaluate clinical results and outcomes of a strict cohort of high-energy injuries of the metaphyseal distal tibia with minimal or no intraarticular involvement treated using the minimally invasive plating concept. SETTING: Level II trauma center. DESIGN: Retrospective analysis of a consecutive case series with limb-specific and whole-person outcomes measures. INTERVENTION: Minimally invasive medial plating for high-energy metaphyseal fractures of the distal tibia with little or no intraarticular involvement. MAIN OUTCOME MEASUREMENT: Clinical and radiographic results were assessed at a minimum of 1 year, and outcomes measures were applied at final follow-up at a minimum of 2 years. Limbs were assessed with the American Orthopaedic Foot and Ankle Surgeons (AOFAS) ankle-hindfoot instrument and the method of Olerud and Molander. Patient outcomes were evaluated with the Short Form-36 (SF-36) and the Musculoskeletal Functional Assessment (MFA). RESULTS: Twenty-six patients were followed until healed at an average of 36 months (12-56 months). Mean fracture healing time was 35 weeks (12-112 weeks) with acceptable alignment restored (angulation<or=5 degrees or shortening<or=1 cm) in all but 1 case. Two patients (7%) had loss of fixation and 9 (35%) underwent secondary surgeries to achieve union. Risk factors for healing problems included high grades of fracture comminution, bone loss, and high-grade open injuries (P<0.05). SF-36 outcomes scores in 21 patients at >2 years were comparable to normative data of patients with uninjured limbs, whereas MFA results showed functional deficits in 4 of 10 subsections. CONCLUSIONS: Minimally invasive medial plating will restore limb alignment and yield successful clinical outcomes for high-energy metaphyseal fractures of the distal tibia. Despite the significant reoperation rate and prolonged time to union, most patients can expect a predictable return of function. Strong consideration should be given to adjunctive measures in at-risk patients, including those with highly comminuted fracture patterns, bone loss, or Type II or III open fractures.
目的：本研究旨在评估采用微创接骨板技术治疗的、干骺端胫骨远端高能损伤且关节内累及极少或无关节内累及的严格队列患者的临床结果和预后。 背景：二级创伤中心。 设计：对一系列连续病例进行回顾性分析，采用针对肢体和全人的预后测量方法。 干预：对干骺端胫骨远端高能骨折且关节内累及极少或无关节内累及的患者采用微创内侧接骨板固定。 主要结局测量指标：至少在1年时评估临床和影像学结果，并在至少2年的最终随访时应用预后测量指标。采用美国矫形足踝外科医师学会（AOFAS）踝-后足评分工具和奥勒鲁德与莫兰德方法对肢体进行评估。采用简明健康状况调查量表（SF-36）和肌肉骨骼功能评估量表（MFA）对患者预后进行评估。 结果：26例患者随访至骨折愈合，平均随访36个月（12 - 56个月）。平均骨折愈合时间为35周（12 - 112周），除1例患者外，所有患者均恢复了可接受的对线（成角≤5°或缩短≤1 cm）。2例患者（7%）出现内固定失败，9例患者（35%）接受二次手术以实现骨折愈合。愈合问题的危险因素包括骨折粉碎程度高、骨缺损和高能量开放性损伤（P<0.05）。21例患者在2年以上的SF-36预后评分与未受伤肢体患者的标准数据相当，而MFA结果显示10个亚组中有4个存在功能缺陷。 结论：微创内侧接骨板固定可恢复肢体对线，并为干骺端胫骨远端高能骨折带来成功的临床结果。尽管再次手术率较高且骨折愈合时间延长，但大多数患者的功能有望得到可预测的恢复。对于高危患者，包括骨折粉碎严重、存在骨缺损或II型或III型开放性骨折的患者，应充分考虑采取辅助措施。
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