Vallier Heather A
Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.
J Orthop Trauma. 2016 Nov;30 Suppl 4:S2-S6. doi: 10.1097/BOT.0000000000000692.
Displaced distal tibia shaft fractures are effectively treated with standard plates and intramedullary nails. Plate fixation performed with meticulous soft tissue handling results in minimal risks of infection and poor wound healing. Standard plates have high rates of primary union, whereas locking plates may delay union because of increased stiffness. Tibial healing may also be delayed after plating of the fibula, although fibula reduction and fixation may aid accuracy of reduction of the tibia. Malalignment occurs more often with infrapatellar intramedullary nailing versus plates, and early results of suprapatellar nailing appear promising in minimizing intraoperative malalignment. Long-term function after fixation of the distal tibia is good for most, with poor outcomes often associated with baseline social and mental health issues.
移位的胫骨干远端骨折采用标准钢板和髓内钉治疗效果良好。在进行钢板固定时精心处理软组织可将感染风险和伤口愈合不良的风险降至最低。标准钢板的一期愈合率较高，而锁定钢板可能因刚度增加而延迟愈合。腓骨钢板固定后胫骨愈合也可能延迟，尽管腓骨复位和固定有助于提高胫骨复位的准确性。与钢板相比，髌下髓内钉固定更常出现对线不良，而髌上髓内钉固定的早期结果在将术中对线不良降至最低方面似乎很有前景。大多数患者胫骨远端固定后的长期功能良好，不良结果通常与基线社会和心理健康问题有关。
