前内侧入路拉力钉固定并自体骨植骨治疗陈旧性内踝骨折的疗效

韩俊柱; 朱勋兵; 张仲传; 徐文弟; 王旭东

doi:10.16766/j.cnki.issn.1674-4152.002497

前内侧入路拉力钉固定并自体骨植骨治疗陈旧性内踝骨折的疗效

doi: 10.16766/j.cnki.issn.1674-4152.002497

蚌埠医学院第二附属医院骨科，安徽蚌埠 233000

基金项目:

安徽省卫生健康委科研项目 AHWJ2021a008

安徽省卫生健康委科研项目 AHWJ2021b126

详细信息

通讯作者:
韩俊柱, E-mail: hanjunzhu1979@163.com

中图分类号: R683.42R687.32
计量
- 文章访问数: 167
- HTML全文浏览量: 61
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2021-08-08
- 网络出版日期: 2022-09-21

The effect of old medial malleolus fracture via anterior medial approach with lag screw fixation and autogenous bone graft

Department of Orthopaedics, the Second Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233000, China

摘要

摘要: 目的探讨经前内侧入路拉力钉固定并自体骨植骨治疗陈旧性内踝骨折的疗效，为此类临床问题的解决提供参考。方法 2018年1月—2019年12月蚌埠医学院第二附属医院收治陈旧性内踝骨折患者9例，均为扭伤所致，术前曾行时间不等的非手术治疗，病程为43~128(83.0±34.6)d。采用前内侧入路切开复位拉力螺钉固定并自体松质骨植骨治疗，3例伴三角韧带损伤者加用带线锚钉修复。术后观测骨折愈合时间、手术并发症，测量并比较术前及末次随访时内踝间隙宽度及踝-后足评分系统(AOFAS)评分评价其疗效。结果 9例患者随访12~36(24.7±7.6)个月，术后3~5(3.8±0.7)个月骨折愈合，无血管神经损伤、踝关节不稳或创伤性关节炎。末次随访时，内踝间隙宽度由(4.4±0.9)mm缩小至(2.4±0.3)mm，AOFAS评分由(47.3±6.2)分升高至(93.4±9.3)分，与术前比较差异有统计学意义(均P < 0.01)。依据AOFAS评分，优6例，良2例，可1例，优良率为88.9%。结论前内侧入路拉力钉固定并自体骨植骨治疗陈旧性内踝骨折，骨折愈合率高，并发症少，足踝功能恢复良好。
- 陈旧性内踝骨折 /
- 入路 /
- 切开复位 /
- 内固定 /
- 植骨
Abstract: Objective To explore the effect of old medial malleolus fracture via anterior medial approach with lag screw fixation and autogenous bone graft to provide a reference for the treatment of this kind of clinical problem. Methods From January 2018 to December 2019, nine patients with old medial malleolus fracture because of sprain were admitted. They went through non-surgical treatment for different times. The treatment course ranged from 43 to 128 (83.0±34.6) days. The patients were treated with open reduction and lag screw fixation and autogenous cancellous bone graft via anterior medial approach. Three cases with deltoid ligament injury were repaired with suture anchor. Fracture healing time and operative complications were observed after the operation. The medial malleolus gap width and AOFAS score were compared before operation and at the last follow-up. Results Nine patients were followed up for 12-36 (24.7±7.6) months. The fracture healing time was 3-5 (3.8±0.7) months. No complications such as blood vessel and nerve injury, unstable ankle and traumatic arthritis were observed. At the last follow-up, the medial malleolus gap width decreased from (4.4±0.9) mm to (2.4±0.3) mm, and the AOFAS score increased from (47.3±6.2) points to (93.4±9.3) points. There were significant differences between preoperative values and values at the last follow-up (all P < 0.01). According to the AOFAS score, six cases were excellent, two cases were good, and one case was fair. The excellent and good rate was 88.9%. Conclusion In the treatment of old medial malleolus fracture, lag screw fixation and autogenous bone graft via anterior medial approach have the advantages of high rate of fracture healing, few complications and good recovery of foot-ankle function.
- Old medial malleolus fracture /
- Approach /
- Open reduction /
- Internal fixation /
- Bone graft

HTML全文

图 1 内踝陈旧性骨折典型病例

注：患者，男，23岁，右内踝陈旧性骨折。A为术前X线示右内踝骨折移位，间隙增宽；B为术后X线示内踝骨折解剖复位、螺钉固定；C为术后4个月X线示内踝骨折线模糊；D为术后2年X线示内踝螺钉已取出，内外踝间隙等宽，无创伤性关节炎表现；E为术后2年足踝功能。

Figure 1. Typical case of old fracture of medial malleolus

下载: 全尺寸图片幻灯片

表 1 术前与末次随访时患者内踝间隙宽度及AOFAS评分比较(x±s)

Table 1. Comparison of medial malleolus space width and AOFAS score between preoperative and last follow-up (x±s)

组别	内踝间隙宽度(mm)	AOFAS评分(分)
术前	4.4±0.9	47.3±6.2
末次随访时	2.4±0.3	93.4±9.3
t值	7.589	-32.505
P值	＜0.001	＜0.001

下载: 导出CSV

参考文献(22)

[1]	何亚标, 孙俊明, 陈振南, 等. 手法复位石膏固定治疗踝关节骨折50例[J]. 中国中医骨伤科杂志, 2020, 28(10): 47-51. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZG202010012.htm HE Y B, SUN J M, CHEN Z N, et al. Treatment of 50 cases of ankle joint fracture with manual reduction and plaster fixation[J]. Chinese Journal of Traditional Medical Traumatology & Orthopedics, 2020, 28(10): 47-51. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZG202010012.htm
[2]	MATSON A P, BARCHICK S R, ADAMS S B. Comparison of open reduction and internal fixation versus closed reduction and percutaneous fixation for medial malleolus fractures[J]. J Am Acad Orthop Surg Glob Res Rev, 2017, 1(8): e48.
[3]	薛清佩, 邹云涛, 潘进贤, 等. 可吸收螺钉治疗不同类型的内踝骨折[J]. 中华关节外科杂志(电子版), 2020, 14(1): 124-127. doi: 10.3877/cma.j.issn.1674-134X.2020.01.023 XUE Q P, ZOU Y T, PAN J X, et al. Bioabsorbable screws for different types of medial malleolus fractures[J]. Chinese Journal of Joint Surgery (Electronic Edition), 2020, 14(1): 124-127. doi: 10.3877/cma.j.issn.1674-134X.2020.01.023
[4]	赵家立, 孙强, 苏云, 等. 带孔金属骨针钛缆张力带与克氏针钢丝张力带治疗内踝骨折疗效比较[J]. 临床骨科杂志, 2018, 21(3): 350-353. doi: 10.3969/j.issn.1008-0287.2018.03.039 ZHAO J L, SUN Q, SU Y, et al. Efficacy comparison of cannulated metal bone needle titanium cable tension band and Kirschner wire tension band for treatment of medial malleolus fractures[J]. Journal of Clinical Orthopaedics, 2018, 21(3): 350-353. doi: 10.3969/j.issn.1008-0287.2018.03.039
[5]	李应池, 王晓霞, 张文文. 手术治疗不稳定性踝关节骨折[J]. 临床骨科杂志, 2019, 22(5): 616-619. https://www.cnki.com.cn/Article/CJFDTOTAL-LCGK201905045.htm LI Y C, WANG X X, ZHANG W W. Operative treatment for unstable ankle fractures[J]. Journal of Clinical Orthopaedics, 2019, 22(5): 616-619. https://www.cnki.com.cn/Article/CJFDTOTAL-LCGK201905045.htm
[6]	王珺琛, 曹湘予, 杨玉山, 等. 后外侧联合内踝后侧入路内固定治疗后Pilon骨折[J]. 中国骨与关节损伤杂志, 2020, 35(12): 1316-1318. doi: 10.7531/j.issn.1672-9935.2020.12.031 WANG J C, CAO X Y, YANG Y S, et al. Posterolateral combined with medial malleolus posterior approach for the treatment of Pilon fracture[J]. Chinese Journal of Bone and Joint Injury, 2020, 35(12): 1316-1318. doi: 10.7531/j.issn.1672-9935.2020.12.031
[7]	廖颖翀, 冯国英, 张辉, 等. 切开复位内固定治疗踝关节骨折[J]. 临床骨科杂志, 2020, 23(4): 587-589. doi: 10.3969/j.issn.1008-0287.2020.04.045 LIAO Y C, FENG G Y, ZHANG H, et al. Open reduction and internal fixation for ankle fracture[J]. Journal of Clinical Orthopaedics, 2020, 23(4): 587-589. doi: 10.3969/j.issn.1008-0287.2020.04.045
[8]	张景波, 燕树义. 距骨侧锚钉联合内踝部金属垫片修复踝关节骨折伴三角韧带深层断裂的疗效[J]. 创伤外科杂志, 2020, 22(1): 59-62. https://www.cnki.com.cn/Article/CJFDTOTAL-CXWK202001018.htm ZHANG J B, YAN S Y. Effect of talar anchor and internal iliac metal pad on repairing ankle fracture combined with deep rupture of deltoid ligament[J]. Journal of Traumatic Surgery, 2020, 22(1): 59-62. https://www.cnki.com.cn/Article/CJFDTOTAL-CXWK202001018.htm
[9]	祁义民, 曾逸文, 赵磊, 等. 胫骨远端内侧钩微型钢板治疗垂直型内踝骨折的临床研究[J]. 生物骨科材料与临床研究, 2021, 18(1): 27-30, 35. doi: 10.3969/j.issn.1672-5972.2021.01.007 QI Y M, ZENG Y W, ZHAO L, et al. Clinical study of the treatment in the vertical medial malleolus fractures of the distal tibia with the medial hook mircoplate[J]. Orthopaedic Biomechanics Materials and Clinical Study, 2021, 18(1): 27-30, 35. doi: 10.3969/j.issn.1672-5972.2021.01.007
[10]	ZHENG X X, CAO Y, ZHENG Y F, et al. Distal radius T-Plate for 18 patients with vertical shear medial malleolus fractures[J]. China J Orthop Trauma, 2020, 33(3): 265-268.
[11]	段霄, 孟庆丰, 汪军玉, 等. 无头双加压螺钉与空心螺钉内固定治疗踝关节骨折的疗效对比研究[J]. 创伤外科杂志, 2020, 22(9): 701-704, 708. https://www.cnki.com.cn/Article/CJFDTOTAL-CXWK202009011.htm DUAN X, MENG Q F, WANG J Y, et al. Comparative study of the effect of headless double compression screw and hollow screw internal fixation in the treatment of ankle fracture[J]. Journal of Traumatic Surgery, 2020, 22(9): 701-704, 708. https://www.cnki.com.cn/Article/CJFDTOTAL-CXWK202009011.htm
[12]	张国辉, 田伟峰, 李华, 等. 无头加压螺钉与空心钉固定踝关节骨折的比较[J]. 中国矫形外科杂志, 2021, 29(2): 102-105. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJXS202102003.htm ZHANG G H, TIAN W F, LI H, et al. Headless compression screw versus cannulated screw for internal fixation of ankle fractures[J]. Orthopedic Journal of China, 2021, 29(2): 102-105. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJXS202102003.htm
[13]	张军, 陈晓, 曹烈虎, 等. 微型锁定钢板与无头空心螺钉在斜型内踝骨折治疗中的疗效对比[J]. 中华全科医学, 2017, 15(4): 552-554. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.002 ZHANG J, CHEN X, CAO L H, et al. Comparison of the effects of micro-locking plate and headless compression screw in oblique fracture of the medial malleolus[J]. Chinese Journal of General Practice, 2017, 15(4): 552-554. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.002
[14]	朱春晖, 周维波, 吴昊, 等. 踝关节骨折手术入路及内固定方法的选择[J]. 中国骨与关节损伤杂志, 2021, 36(6): 631-632. https://www.cnki.com.cn/Article/CJFDTOTAL-GGJS202106025.htm ZHU C H, ZHOU W B, WU H, et al. Choice of surgical approach and internal fixation method for ankle fracture[J]. Chinese Journal of Bone and Joint Injury, 2021, 36(6): 631-632. https://www.cnki.com.cn/Article/CJFDTOTAL-GGJS202106025.htm
[15]	KURU T, AKPINAR F, IŞIK C, et al. Biomechanical comparison of a new handy tension band with malleolar screw, bicortical screw and conventional tension band for the fixation of transverse medial malleolar fractures[J]. Eklem Hastalik Cerrahisi, 2019, 30(3): 301-308. doi: 10.5606/ehc.2019.66919
[16]	潘艳华, 江劲明, 徐志庆, 等. 踝关节骨折并三角韧带损伤给予三角韧带修复的疗效分析[J]. 中国骨与关节杂志, 2021, 10(2): 128-133. https://www.cnki.com.cn/Article/CJFDTOTAL-GZGL202102014.htm PAN Y H, JIANG J M, XU Z Q, et al. Deltoid ligament repair in the treatment of ankle fracture with deltoid ligament injury[J]. Chinese Journal of Bone and Joint, 2021, 10(2): 128-133. https://www.cnki.com.cn/Article/CJFDTOTAL-GZGL202102014.htm
[17]	常小波, 王勤业, 习洪波, 等. 踝关节骨折合并三角韧带完全断裂21例的手术疗效分析[J]. 中国骨伤, 2020, 33(7): 655-658. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGU202007012.htm CHANG X B, WANG Q Y, XI H B, et al. Operation-effect analysis of 21 patients with ankle fracture and complete rupture of deltoid ligament[J]. China Journal of Orthopaedics and Traumatology, 2020, 33(7): 655-658. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGU202007012.htm
[18]	徐厚高, 程宇, 冯炜炜, 等. 踝关节骨折合并三角韧带断裂术中修复与不修复深层三角韧带的疗效比较[J]. 中国骨与关节损伤杂志, 2020, 35(12): 1314-1316. doi: 10.7531/j.issn.1672-9935.2020.12.030 XU H G, CHENG Y, FENG W W, et al. Comparison of intraoperative repair and non-repair of the deep deltoid ligament in ankle fracture complicated with deltoid ligament rupture[J]. Chinese Journal of Bone and Joint Injury, 2020, 35(12): 1314-1316. doi: 10.7531/j.issn.1672-9935.2020.12.030
[19]	李静, 李良黎, 卢鸿, 等. 锚钉修复踝关节三角韧带断裂[J]. 临床骨科杂志, 2019, 22(4): 510. doi: 10.3969/j.issn.1008-0287.2019.04.048 LI J, LI L L, LU H, et al. Suture anchor for repairing ruptured deltoid ligament[J]. Journal of Clinical Orthopaedics, 2019, 22(4): 510. doi: 10.3969/j.issn.1008-0287.2019.04.048
[20]	叶永志, 胡妙仙, 叶颂华. 可吸收锚钉修复三角韧带损伤在踝关节骨折术中的应用[J]. 中国骨与关节损伤杂志, 2020, 35(6): 641-642. https://www.cnki.com.cn/Article/CJFDTOTAL-GGJS202006033.htm YE Y Z, HU M X, YE S H. Application of absorbable anchor in repairing deltoid ligament injury in ankle fracture[J]. Chinese Journal of Bone and Joint Injury, 2020, 35(6): 641-642. https://www.cnki.com.cn/Article/CJFDTOTAL-GGJS202006033.htm
[21]	张国锋, 任甜甜, 郑钧水, 等. 锚钉修补联合切开复位内固定术治疗踝关节三踝骨折伴内侧副韧带损伤疗效分析[J]. 中华全科医学, 2020, 18(7): 1093-1095, 1173. doi: 10.16766/j.cnki.issn.1674-4152.001436 ZHANG G F, REN T T, ZHENG J S, et al. Analysis of the curative effect of anchor repair combined with open reduction and internal fixation in the treatment of ankle trimalleolar fracture with medial collateral ligament injury[J]. Chinese Journal of General Practice, 2020, 18(7): 1093-1095, 1173. doi: 10.16766/j.cnki.issn.1674-4152.001436
[22]	陈斌, 李岩, 李飞, 等. 带线锚钉修复踝关节骨折合并三角韧带损伤疗效观察[J]. 中国骨与关节损伤杂志, 2021, 36(6): 583-585. https://www.cnki.com.cn/Article/CJFDTOTAL-GGJS202106006.htm CHEN B, LI Y, LI F, et al. Repair of ankle joint fractures with deltoid ligament injury with wire anchor[J]. Chinese Journal of Bone and Joint Injury, 2021, 36(6): 583-585. https://www.cnki.com.cn/Article/CJFDTOTAL-GGJS202106006.htm