Lin Chuanlu, Lin Lixiang, Vinesh Lutchooman, Shao Xiwen, Lu Xiaolang, Hong Jianjun
Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325027, China.
Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuanxi Road, Wenzhou, 325027, China.
Injury. 2017 Jun;48(6):1224-1228. doi: 10.1016/j.injury.2017.03.015. Epub 2017 Mar 19.
Distal tibial nonunion is usually due to severe open distal tibial fractures with high energy injury. The best surgical treatment is not well established because of the poor soft tissue condition. We retrospectively analyzed a series of patients with distal tibial nonunion after severe open distal tibial fractures; our purpose was to introduce a treatment using a contralateral anterior L-shaped locking compression plate through a posterior-lateral approach with Iliac crest bone graft and evaluate the outcomes of patients.
All patients with distal tibial nonunion who received a contralateral anterior L-shaped locking compression plate fixation through the posterior-lateral approach with Iliac crest bone graft by a single surgeon from 2014 to 2016 were reviewed. 9 patients met the criteria. Five of nine patients had varus deformities (range, 9-40°) and 4 patients had valgus deformities (range, 5-30°). Postoperative radiographs, Postoperative complications, limb alignment and limb functional outcome information of AOFAS ankle-hindfoot score were recorded.
All patients were followed up for at least 8 months (range, 8-16 months). Union was achieved in all patients after the index surgery without postoperative wound complications while one patient came up with checkrein deformity. Average time to radiographic union was 16 weeks (range, 12-24 weeks). All patients had correction to neutral alignment in both coronal and sagittal planes. The average AOFAS ankle-hindfoot score was 90 (range, 77-100) at the last follow-up of patients.
Using a contralateral anterior L-shaped locking compression plate fixation through a posterior-lateral approach with Iliac crest bone graft to reconstruct the distal tibial nonunion is a safe and reliable method that can successfully treat patients with poor soft tissue condition of anterior portion of leg because of its adequate exposure, both tibia and fibula rigid fixation and plenty of bone graft. We believe the application of this method resulting in a high union and low complication rate.
胫骨干远端骨不连通常是由于高能损伤导致的严重开放性胫骨干远端骨折引起。由于软组织条件较差，最佳的手术治疗方法尚未完全确立。我们回顾性分析了一系列严重开放性胫骨干远端骨折后发生胫骨干远端骨不连的患者；我们的目的是介绍一种通过后外侧入路使用对侧前外侧L形锁定加压钢板并取自体髂骨植骨的治疗方法，并评估患者的治疗效果。
回顾性分析2014年至2016年期间由同一位外科医生通过后外侧入路使用对侧前外侧L形锁定加压钢板并取自体髂骨植骨治疗的所有胫骨干远端骨不连患者。9例患者符合标准。9例患者中有5例存在内翻畸形（范围为9-40°），4例患者存在外翻畸形（范围为5-30°）。记录术后X线片、术后并发症、肢体对线情况以及AOFAS踝-后足评分的肢体功能结局信息。
所有患者均至少随访8个月（范围为8-16个月）。初次手术后所有患者均实现骨愈合，术后无伤口并发症，1例患者出现跟腱挛缩畸形。影像学骨愈合的平均时间为16周（范围为12-24周）。所有患者在冠状面和矢状面均矫正至中立对线。患者最后一次随访时AOFAS踝-后足评分的平均值为90分（范围为77-100分）。
通过后外侧入路使用对侧前外侧L形锁定加压钢板并取自体髂骨植骨来重建胫骨干远端骨不连是一种安全可靠的方法，由于其暴露充分、胫腓骨坚强固定且植骨量充足，能够成功治疗小腿前部软组织条件较差的患者。我们认为该方法的应用可实现高骨愈合率和低并发症发生率。
