Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 555, East Youyi Road, Xi'an, 710000, Shaanxi, People's Republic of China.
BMC Musculoskelet Disord. 2023 Mar 30;24(1):244. doi: 10.1186/s12891-023-06319-8.
Spiral fracture of tibia combined with posterior malleolar fracture (PMF) is a special and regular injury. There is no uniform fixation method for PMF in this kind of injury. Intramedullary nail is the first choice for the treatment of tibial spiral fracture. We proposed a minimally invasive percutaneous screw combined with intramedullary nail technology to fix the PMF in the tibial spiral fracture. This study aims to explore the effectiveness and advantages of this technology.
From January 2017 to February 2020, 116 cases of spiral fracture of tibia combined with PMF who were operated in our hospital were divided into Fixation Group (FG) and No Fixation Group (NG) according to whether PMF was fixed. After minimally invasive percutaneous screw fixation of ankle fracture in FG patients, the tibial intramedullary nail was inserted to fix the fracture. Collected the operation and postoperative recovery of the two groups of patients, including the operation time, intraoperative blood loss, AOFAS score, VAS score and dorsiflexion restriction of ankle joint at the last follow-up, and compared whether there is any difference between the two groups of patients.
The fracture of both groups healed.2 patients in NG had secondary displacement of PMF during operation, and the fracture finally healed after fixation. There were statistical differences between the two groups in terms of operation time, AOFAS score and weight bearing time. The operation time of FG was 67.9±11.2 min, and that of NG was 60.8±9.4 min; The weight bearing time of FG was 57.35±34.72 days, and that of NG was 69.17±21.43 days; The AOFAS score of FG was 92.50±3.46, and that of NG was 91.00±4.16. There were no significant difference in blood loss, VAS and dorsiflexion restriction of ankle joint between the two groups. The blood loss of FG was 66.8±12.3 ml, the blood loss of NG was 65.6±11.7 ml, the VAS score of FG was 1.37±0.47, the VAS score of NG was 1.43±0.51, the dorsiflexion restriction of FG was 5.8±4.1; the NG was 6.1±5.7.
For the injury of tibial spiral fracture combined with PMF, our fixation technology can achieve minimally invasive fixation of PMF with percutaneous screws on the basis of intramedullary nail fixation of tibial fracture, promoting early functional exercise of ankle joint and early weight bearing of patients. This fixation technology is also characterized by simple and fast operation.
胫骨螺旋骨折合并后踝骨折（PMF）是一种特殊且常见的损伤。对于此类损伤，PMF 没有统一的固定方法。髓内钉是治疗胫骨螺旋骨折的首选方法。我们提出了一种微创经皮螺钉联合髓内钉技术来固定胫骨螺旋骨折合并的 PMF。本研究旨在探讨该技术的有效性和优势。
自 2017 年 1 月至 2020 年 2 月，我院共收治 116 例胫骨螺旋骨折合并 PMF 患者，根据 PMF 是否固定将患者分为固定组（FG）和未固定组（NG）。FG 患者踝关节骨折微创经皮螺钉固定后，插入胫骨髓内钉固定骨折。收集两组患者的手术和术后恢复情况，包括手术时间、术中出血量、AOFAS 评分、VAS 评分和末次随访时踝关节背屈受限，并比较两组患者是否存在差异。
两组骨折均愈合。NG 组有 2 例患者在术中出现 PMF 二次移位，最终经固定后骨折愈合。两组患者在手术时间、AOFAS 评分和负重时间方面存在统计学差异。FG 组手术时间为 67.9±11.2min，NG 组手术时间为 60.8±9.4min；FG 组负重时间为 57.35±34.72d，NG 组负重时间为 69.17±21.43d；FG 组 AOFAS 评分为 92.50±3.46，NG 组 AOFAS 评分为 91.00±4.16。两组患者术中出血量、VAS 评分和踝关节背屈受限无显著差异。FG 组出血量为 66.8±12.3ml，NG 组出血量为 65.6±11.7ml，FG 组 VAS 评分为 1.37±0.47，NG 组 VAS 评分为 1.43±0.51，FG 组踝关节背屈受限为 5.8±4.1°，NG 组为 6.1±5.7°。
对于胫骨螺旋骨折合并 PMF 的损伤，我们的固定技术可以在胫骨骨折髓内钉固定的基础上，通过经皮螺钉微创固定 PMF，促进踝关节的早期功能锻炼和患者的早期负重。该固定技术还具有操作简单、快速的特点。
