本文選題：螺旋形脛腓骨骨折 + 后踝骨折��； 參考：《大連醫(yī)科大學》2017年碩士論文

【摘要】：目的:螺旋形脛腓骨骨折在下肢長骨干骨折中經常發(fā)生,螺旋形脛腓骨骨折合并同側后踝骨折近些年也越來越被大家熟知,然而對于所合并后踝骨折是否需要內固定、后踝骨折所占脛骨遠端關節(jié)面多大比例時需要固定以及如何固定一直存在爭議,不同的骨科醫(yī)生都有不同的標準。本文的研究目的就是評估螺旋形脛腓骨骨折合并后踝骨折的治療選擇從而為這一類型骨折提供更好的治療建議。方法:回顧性分析了 2013年1月-2016年11月大連醫(yī)科大學附屬第一醫(yī)院創(chuàng)傷骨科收治的123例所有的脛腓骨骨折患者,其中螺旋形脛腓骨骨折(A0分型為42-A1、42-B1、42-C1)同時合并后踝骨折的病例共29例,其中有13例行后踝骨折內固定,有16例后踝骨折未行內固定但全部行術后石膏外固定,我們以既往文獻中有爭議的后踝骨折所占遠端關節(jié)面25%比例為基準進行研究,分別將后踝骨折大于等于遠端關節(jié)面25%病例以及小于25%病例進行單獨分組,然后將后踝骨折是否進行內固定分為固定組與非固定組,通過手術時間、術后負重時間、AOFAS踝與后足評分及創(chuàng)傷后關節(jié)炎進行比較并做統(tǒng)計學分析,從而比較各組的臨床療效。結果:123例脛腓骨骨折的患者中共有29例(23.6%)為螺旋形脛腓骨骨折合并后踝骨折,其中9例(31.03%)后踝骨折≥25%脛骨遠端關節(jié)面,20例(68.94%)后踝骨折25%脛骨遠端關節(jié)面。在后踝骨折≥25%脛骨遠端關節(jié)面的病例中,后踝骨折固定組共有4例(44.44%),非固定組有5例(55.56%),通過比較兩組相關數(shù)據(jù),在手術時間方面有統(tǒng)計學意義,后踝固定組大于后踝非固定組;在術后患肢負重時間方面有統(tǒng)計學差異,后踝固定組早于后踝非固定組;在AOFAS評分方面有統(tǒng)計學差異,固定組明顯好于非固定組;兩組均無創(chuàng)傷性骨性關節(jié)炎發(fā)生。在20例后踝骨折25%脛骨遠端關節(jié)面的病例中,有9例(45.0%)后踝骨折被固定為固定組,有11例(55.0%)后踝骨折未被固定為非固定組,通過比較兩組相關數(shù)據(jù),在手術時間方面有統(tǒng)計學意義,后踝固定組大于后踝非固定組;在術后患肢負重時間方面有統(tǒng)計學意義,后踝固定組早于后踝非固定組;在AOFAS評分方面無統(tǒng)計學差異,且都大于90分,均令人滿意,兩組均無創(chuàng)傷性骨性關節(jié)炎發(fā)生。結論:在后踝骨折≥25%脛骨遠端關節(jié)面的病例中,后踝固定組與后踝非固定組相比術后患肢負重時間更早、AOFAS評分更高,臨床療效更好,因此后踝骨折需行內固定手術。在后踝骨折25%脛骨遠端關節(jié)面的病例中,后踝固定組與后踝非固定組相比雖然術后患肢負重時間更早,但是手術時間更長,AOFAS評分無明顯差別(90分)均令人滿意,臨床療效并無明顯差別,且增加了患者的手術費用、給患者帶來了更大的創(chuàng)傷,因此我們覺得后踝骨折無需內固定手術,石膏外固定治療即可。
[Abstract]:Objective: spiral tibia and fibula fractures occur frequently in the long shaft fractures of the lower extremities. Spiral tibiofibula fractures with ipsilateral posterior malleolar fractures are more and more well known in recent years. The ratio of posterior ankle fracture to distal tibial articular surface is controversial, and different orthopedic doctors have different standards. The purpose of this study is to evaluate the treatment choice of helical tibiofibula fracture combined with posterior ankle fracture to provide better treatment advice for this type of fracture. Methods: 123 patients with tibia and fibula fractures treated in Department of Trauma and Orthopaedics, first affiliated Hospital of Dalian Medical University, from January 2013 to November 2016, were retrospectively analyzed. Among them, 29 cases of spiral tibiofibula fracture (A0 type 42-A1n42-B1F42-C1) were combined with posterior malleolar fracture. 13 cases were treated with posterior malleolar fracture internal fixation, 16 cases with posterior malleolar fracture without internal fixation but all cases were treated with plaster external fixation after operation. Based on the 25% ratio of posterior malleolar fracture to distal articular surface in previous literatures, we grouped 25% of cases with posterior malleolar fracture greater than 25% of distal articular surface and less than 25% of cases with less than 25% of posterior malleolar fracture. Then, the posterior ankle fracture was divided into fixed group and non-fixed group. Through the operation time, the weight bearing time and AOFAS ankle score and post-traumatic arthritis were compared and statistically analyzed, so as to compare the clinical efficacy of each group. Results among 123 cases of tibiofibula fracture, 29 cases (23.6%) were spiral tibiofibula fracture with posterior malleolar fracture, 9 cases (31.03%) had posterior ankle fracture 鈮，

本文編號：2058495