改良Z形截骨术联合解剖锁定钢板内固定治疗陈旧性腓骨远端骨折畸形愈合
摘要
目的探讨改良Z形截骨术联合解剖锁定钢板内固定治疗陈旧性腓骨远端骨折畸形愈合的临床疗效。方法回顾性分析自2010-03-2015-01采用改良Z形截骨术联合解剖锁定钢板内固定治疗11例陈旧性腓骨远端骨折畸形愈合。常规完成腓骨远端Z形截骨后,将截骨形成的外侧臂外旋,于其内侧面与腓骨纵轴45°斜行截骨,腓骨延长及去外旋畸形后,腓骨外侧放置锁定解剖钢板固定。结果 11例均获随访,随访时间平均18.3(9～28)个月。术后踝穴位X线片显示11例踝关节力线得到矫正,腓骨延长4～8 mm,腓骨截骨端均骨性愈合,愈合时间平均12.4(12～16)周。术后踝关节活动度较术前无明显改善。末次随访时AOFAS功能评分为(83.4±2.2)分,优6例,良3例,可1例,差1例。末次随访时疼痛VAS评分为(3.0±2.3)分,较术前明显改善。结论改良Z形截骨术更有效地去旋转矫正陈旧性腓骨远端骨折畸形愈合,操作简便,恢复了正常的踝穴,增加了踝关节稳定性,并且可减少并发症的发生。
引文
[1]Weber D,Borisch N,Weber M.Treatment of malunion in ankle fractures[J].Eur J Trauma Emerg Surg,2010,36(6):521-524.
[2]Van Wensen RJ,Van den Bekerom MP,Marti RK,et al.Reconstructive osteot omy of fibular malunion:review of the literature[J].Strateqies Trauma Limb Reconstr,2011,6(2):51-57.
[3]Thordarson DB,Motamed S,Hedman T,et al.The effect of fibular malreduction on contact pressures in an ankle fracture malunion model[J].J Bone Surg Surg Am,1997,79(12):1809-1815.
[4]Ramsey PL,Hamiltom W.Changes in tibiotalar area of contact caused by lateral talar shift[J].J Bone Joint Surg Am,1976,58(3):356-357.
[5]Glazebrook M,Amirault J,Arsenault K,et al.Early follow-up of the fibular sparing“z”osteotomy ankle arthrodesis:clinical outcome and gait analysis[J].J Bone Joint Surg Br,2009,91 Suppl:235-236.
[6]Marti RK,Raaymakers EL,Nolte PA.Malunited ankle fractures.The late results of reconstruction[J].J Bone Joint Surg Br,1990,72(4):709-713.
[7]Gianini S,Faldini C,Acri F,et al.Surgical treatment of post-traumatic malalignment of the ankle[J].Injury,2010,41(11):1208-1211.
[8]Perera A,Myerson M.Surgical techniques for the reconstruction of malunited ankle fractures[J].Foot Ankle Clin,2008,13(4):737-751.
[9]Brin YS,Palmanovich E,Massarwe S,et al.Using a cervical spine cage to reconstruct malunited fibular fractures[J].Int Orthop,2013,37(3):447-450.
[10]Chao KH,Wu CC,Lee CH,et al.Corrective-elongation osteotomy without bone graft for old ankle fracture with residual daistasis[J].Foot Ankle Int,2004,25(3):123-127.
[2]Van Wensen RJ,Van den Bekerom MP,Marti RK,et al.Reconstructive osteot omy of fibular malunion:review of the literature[J].Strateqies Trauma Limb Reconstr,2011,6(2):51-57.
[3]Thordarson DB,Motamed S,Hedman T,et al.The effect of fibular malreduction on contact pressures in an ankle fracture malunion model[J].J Bone Surg Surg Am,1997,79(12):1809-1815.
[4]Ramsey PL,Hamiltom W.Changes in tibiotalar area of contact caused by lateral talar shift[J].J Bone Joint Surg Am,1976,58(3):356-357.
[5]Glazebrook M,Amirault J,Arsenault K,et al.Early follow-up of the fibular sparing“z”osteotomy ankle arthrodesis:clinical outcome and gait analysis[J].J Bone Joint Surg Br,2009,91 Suppl:235-236.
[6]Marti RK,Raaymakers EL,Nolte PA.Malunited ankle fractures.The late results of reconstruction[J].J Bone Joint Surg Br,1990,72(4):709-713.
[7]Gianini S,Faldini C,Acri F,et al.Surgical treatment of post-traumatic malalignment of the ankle[J].Injury,2010,41(11):1208-1211.
[8]Perera A,Myerson M.Surgical techniques for the reconstruction of malunited ankle fractures[J].Foot Ankle Clin,2008,13(4):737-751.
[9]Brin YS,Palmanovich E,Massarwe S,et al.Using a cervical spine cage to reconstruct malunited fibular fractures[J].Int Orthop,2013,37(3):447-450.
[10]Chao KH,Wu CC,Lee CH,et al.Corrective-elongation osteotomy without bone graft for old ankle fracture with residual daistasis[J].Foot Ankle Int,2004,25(3):123-127.