临床骨科杂志Issue(5)：615-617,618,4.DOI:10.3969/j.issn.1008-0287.2015.05.045
胫骨下段螺旋型骨折合并后踝骨折的诊断与治疗
Diagnosis and treatment of the distal spiral tibial shaft fracture associated with posterior mal-leolar fracture
张正廉 1王士波 1高迪 1郑杰 1赵廷虎 1高彦军 1张勇1
作者信息
- 1. 深圳平乐骨伤科医院创伤骨科，广东 深圳 518010
- 折叠
摘要
Abstract
Objective To explore the cause of leak diagnosis, injury mechanism and treatment strategy of the distal 1/3 spiral tibial shaft fracture associated with occult posterior malleolar fracture. Methods 81 patients with distal third spiral tibia shaft fracture associated posterior malleolar fractures were treated by surgery. The radiology detected 38 posterior malleolar fracture. The rest fractures were determined by CT scan. All cases were fixed with tibial intr-amedulary nailing at the supination foot and the internal-rotation tibia. The posterior malleolar fractures were fixed with ø 4. 5 mm cannulated screws. All cases of distal 1/2 fibular fractures were fixed with plates or Kirschner wires. All of proximal fibular fractures were not fixed. Results 81 cases were all followed up from 4 months to 11 months. 68 cases of posterior malleolar fractures were fixed with cannulated screws, which can prevent displacement during in-tramedullary nailing of tibia shaft fractures, and all showed radiographic evidence of healing. 13 cases were not fixed for small and no displacement fractures. 79 cases of spiral tibial shaft fracture were healed according to plain radio-graphs standard. 2 cases were ununion for excessive gap between fractures and later healed with bone grafting. 1 case occurred ankle traumatic arthritis. The wounds were not contaminated and no osteomyelitis occurred. According to Johner-Wruhs evaluation standard, the results were excellent in 67 cases, good in 10, fair in 3 and poor in 1;the ex-cellent and good rate was 95%. Conclusions Distal spiral tibia shaft fractures are associated with ipsilateral posteri-or malleolar fractures, which plain radiographs are often insufficient for detecting. Using a preoperative CT protocol for spiral tibial shaft fractures can significantly improve the ability to diagnose associated posterior malleolar fractures that may not be evident on plain radiographs. Injury mechanism is the supination foot and the internal-rotation tibia. The posterior malleolar fractures are fixed with ø 4. 5 mm cannulated screws. Distal 1/2 fibular fractures are fixed with plates or Kirschner wires, proximal fibular fractures are not fixed and distal spiral tibia fractures are fixed with tibial in-tramedulary nailing at the supination foot and the internal-rotation tibia, which can lead to a good clinical results.关键词
胫骨螺旋型骨折/后踝骨折/髓内钉/骨折固定术,内Key words
spiral tibial fracture/posterior malleolar fracture/intramedulary nailing/fracture fixation,internal分类
医药卫生引用本文复制引用
张正廉,王士波,高迪,郑杰,赵廷虎,高彦军,张勇..胫骨下段螺旋型骨折合并后踝骨折的诊断与治疗[J].临床骨科杂志,2015,(5):615-617,618,4.
