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
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- 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

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