髓内钉固定与钢板接骨术治疗胫腓骨远端干骺端骨折
Intramedullary nailing and plate osteosynthesis for fractures of the distal metaphyseal tibia and fibula.
作者信息
Krishan Ajay, Peshin Chetan, Singh Dara
机构信息
Department of Orthopaedics, GMC Jammu, India.
出版信息
J Orthop Surg (Hong Kong). 2009 Dec;17(3):317-20. doi: 10.1177/230949900901700315.
PURPOSE
To assess the results of concurrent intramedullary nailing plus plate osteosynthesis for fractures of the distal tibia and fibula.
METHODS
15 men and 10 women (mean age, 35 years) with concurrent fractures of the distal tibia and fibula underwent intramedullary nailing (for the tibia) and plate osteosynthesis (for the fibula). 17 fractures were type A1, 6 type A2, and 2 type A3. Compound type IIIB or more extensive fractures were excluded.
RESULTS
The mean follow-up duration was 2 years. The mean time to bone union was 20 weeks. Six patients underwent dynamisation and 4 bone grafting. Two patients had malalignment (angulation of >5 degrees in any plane), but none was rotational. No patient had shortening, hardware breakdown, or deep-seated infection. Two patients had superficial cellulitis at the site of the distal locking screws.
CONCLUSION
Concurrent intramedullary nailing and plate osteosynthesis for fractures of the distal tibia and fibula is effective in preventing malalignment. Plate osteosynthesis for the fibula provides additional stability even when a single distal locking bolt is used to fix the intramedullary nail to the tibia.
目的
评估同期髓内钉固定联合钢板接骨术治疗胫腓骨远端骨折的效果。
方法
15例男性和10例女性（平均年龄35岁）的胫腓骨远端同时骨折患者接受了髓内钉固定（用于胫骨）和钢板接骨术（用于腓骨）。17例骨折为A1型，6例为A2型，2例为A3型。排除III B型或更严重的开放性骨折。
结果
平均随访时间为2年。平均骨愈合时间为20周。6例患者进行了动力化处理，4例进行了植骨。2例患者出现对线不良（任何平面成角>5度），但无旋转畸形。没有患者出现短缩、内固定物断裂或深部感染。2例患者在远端锁定螺钉部位出现浅表蜂窝织炎。
结论
同期髓内钉固定联合钢板接骨术治疗胫腓骨远端骨折可有效预防对线不良。即使仅使用单个远端锁定螺栓将髓内钉固定至胫骨，腓骨的钢板接骨术也可提供额外的稳定性。
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