改良开口置入弹性髓内针固定腓骨骨折
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摘要
[目的]探讨改良开口置入弹性髓内针固定腓骨骨折的临床疗效。[方法]回顾性分析2016年6月～2018年5月12例腓骨骨折患者采用改良开口置入弹性髓内针内固定治疗的临床资料。先采用定位导针即直径1.0 mm的克氏针定位,进针方向正位自外踝尖进针,和腓骨长轴有10°～15°外翻角,侧位位于腓骨髓腔中心的延长线上,进针深度一般2 cm;然后使用直径2.8 mm的空心钻打通腓骨远端髓腔,深度也是2cm,再选取直径2.5～3 mm弹性髓内针,沿腓骨通道置入。[结果]所有患者术后获3～27个月随访,平均(16.35±1.24)个月。无感染、骨折不愈合、内固定断裂及松动移位患者。末次随访时AOFAS的踝-后足评分(90.15±5.36)分,临床结果评定为优8例,良4例。[结论]改良开口置入弹性髓内针固定腓骨中下段骨折,操作更加精准,避免改锥开口出现偏差时引起腓骨尖部空洞以及偏内对腓骨关节面的破坏。尤其适合腓骨多段骨折及小腿外侧软组织损伤不允许钢板固定者。
[Objective] To explore the clinical outcomes of modified insertion of elastic intramedullary nail for fibular fractures. [Methods] A retrospective study was conducted on 12 patients who underwent internal fixation with elastic intramedullary nail inserted through a modified entry point for fibular fracturesfrom June 2016 to May 2018. Firstly, a 1.0 mm Kirschner wire was put in as guide pin at the tip of lateral malleolus to depth of 2 cm with valgus angle of 10～15 degrees to fibular longitudinal axis in coronal plane and parallel to the axis in sagittal plane. After that, a 2.8 mm cannulated drill was driven over the guide pin to open the medullary cavity to depth of 2 cm. At the last, an elastic intramedullary nail of 2.5 mm to 3 mm in diameter was selected, and inserted into fibular medullary cavity through the entry hole. [Results] All the patients were followed up for 3 to 27 months with an average of(16.35±1.24) months. No infection, nonunion fracture, loosening and displacement of implant was found in any patients. At the latest follow up, AOFAS score proved(90.15±5.36) on average, associated with excellent results in 8 and good in 4 patients. [Conclusion] This modified insertion of elastic intramedullary nail takes advantages of improving accuracy of operation, and avoiding the bone defect and involvement of the articular surface induced by the awl, is especially suitable to the patients with multiple fragmental fibular fractures and those who are not allowed to be plated due to soft tissue injuries on lateral side of the leg.
[Objective] To explore the clinical outcomes of modified insertion of elastic intramedullary nail for fibular fractures. [Methods] A retrospective study was conducted on 12 patients who underwent internal fixation with elastic intramedullary nail inserted through a modified entry point for fibular fracturesfrom June 2016 to May 2018. Firstly, a 1.0 mm Kirschner wire was put in as guide pin at the tip of lateral malleolus to depth of 2 cm with valgus angle of 10～15 degrees to fibular longitudinal axis in coronal plane and parallel to the axis in sagittal plane. After that, a 2.8 mm cannulated drill was driven over the guide pin to open the medullary cavity to depth of 2 cm. At the last, an elastic intramedullary nail of 2.5 mm to 3 mm in diameter was selected, and inserted into fibular medullary cavity through the entry hole. [Results] All the patients were followed up for 3 to 27 months with an average of(16.35±1.24) months. No infection, nonunion fracture, loosening and displacement of implant was found in any patients. At the latest follow up, AOFAS score proved(90.15±5.36) on average, associated with excellent results in 8 and good in 4 patients. [Conclusion] This modified insertion of elastic intramedullary nail takes advantages of improving accuracy of operation, and avoiding the bone defect and involvement of the articular surface induced by the awl, is especially suitable to the patients with multiple fragmental fibular fractures and those who are not allowed to be plated due to soft tissue injuries on lateral side of the leg.
引文
[1]颜宸,王业华,卢慧,等.腓骨固定在AO42型胫腓骨骨折中的作用[J].实用骨科杂志,2017,23(8):743-746.
[2]夏洪刚,李杰,林炳基.解剖锁定钢板与带锁髓内钉固定骨质疏松外踝骨折的疗效比较[J].中国矫形外科杂志,2014,22(20):1836-1841.
[3]吴伟,刘晓峰,严松鹤,等.弹性髓内钉治疗成人腓骨骨折体会[J].中国医学教育,2016,33(8):143-145.
[4]Rajeev.Functional outcomes after fibula locking nail for fragility fractures of the ankle[J].J Foot Ankle Surg,2011,50(4):547-550.
[5]Megas P,Panagiotopoulos E,Skriviliotakis S,et al.Intramedullary nailing in the treatment of aseptic tibial nonunion[J].Injury,2001,32(3):233-239.
[6]贾瑞钢,王鑫强,张维龙,等.有限切开复位经皮内侧锁定钢板治疗Rüedi-Allg(o)werⅡ、Ⅲ型闭合性Pilon骨折[J].中华创伤杂志,2017,33(10):904-910.
[7]Berlusconi M,Busnelli L,Chiodini F,et al.To fix or not to fix?The role of fibular fixation in distal shaft fractures of the leg[J].Injury,2014,45(2):408-411.
[8]Prasad M,Yadav S,Sud A,et al.Assessment of the role of fibular fixation in distal-third tibia-fibula fractures and its significance in decreasing malrotation and malalignment[J].Injury,2013,44(12):1885-1891.
[9]Bonnevialle P.Distal leg fractures:how critical is the fibular fracture and its fixation[J].Orthop Traumatol Surg Res,2010,96(6):667-673.
[10]Rajeev A.Functional outcomes after fibula locking nail for fragility fractures of the ankle[J].J Foot Ankle Surg,2011,50(5):547-550.
[11]Jordan RW,Chapman A,Buchanan D,et al.The role of intramedullary fixation in ankle fractures-A systematic review[J].Foot Ankle Surg,2018,24(1):1-10.
[12]Challagundla SR,Shewale S,Cree C,et al.Intramedullary fixation of lateral malleolus using Fibula Rod System in ankle fractures in the elderly[J].Foot Ankle Surg,2017,19(24):1-10.
[13]杨云,方跃,钟刚,等.弹性髓内针与钢板螺钉治疗腓骨干骨折的比较研究[J].中华创伤骨科杂志,2018,20(2):172-176.
[14]Wang Q,Xu HG,Zhang YC,et al.Elastic nails for fibular fracture in adult tibiofibular fractures[J].Int J Clin Exp Med,2015,8(6):10086-10090.
[2]夏洪刚,李杰,林炳基.解剖锁定钢板与带锁髓内钉固定骨质疏松外踝骨折的疗效比较[J].中国矫形外科杂志,2014,22(20):1836-1841.
[3]吴伟,刘晓峰,严松鹤,等.弹性髓内钉治疗成人腓骨骨折体会[J].中国医学教育,2016,33(8):143-145.
[4]Rajeev.Functional outcomes after fibula locking nail for fragility fractures of the ankle[J].J Foot Ankle Surg,2011,50(4):547-550.
[5]Megas P,Panagiotopoulos E,Skriviliotakis S,et al.Intramedullary nailing in the treatment of aseptic tibial nonunion[J].Injury,2001,32(3):233-239.
[6]贾瑞钢,王鑫强,张维龙,等.有限切开复位经皮内侧锁定钢板治疗Rüedi-Allg(o)werⅡ、Ⅲ型闭合性Pilon骨折[J].中华创伤杂志,2017,33(10):904-910.
[7]Berlusconi M,Busnelli L,Chiodini F,et al.To fix or not to fix?The role of fibular fixation in distal shaft fractures of the leg[J].Injury,2014,45(2):408-411.
[8]Prasad M,Yadav S,Sud A,et al.Assessment of the role of fibular fixation in distal-third tibia-fibula fractures and its significance in decreasing malrotation and malalignment[J].Injury,2013,44(12):1885-1891.
[9]Bonnevialle P.Distal leg fractures:how critical is the fibular fracture and its fixation[J].Orthop Traumatol Surg Res,2010,96(6):667-673.
[10]Rajeev A.Functional outcomes after fibula locking nail for fragility fractures of the ankle[J].J Foot Ankle Surg,2011,50(5):547-550.
[11]Jordan RW,Chapman A,Buchanan D,et al.The role of intramedullary fixation in ankle fractures-A systematic review[J].Foot Ankle Surg,2018,24(1):1-10.
[12]Challagundla SR,Shewale S,Cree C,et al.Intramedullary fixation of lateral malleolus using Fibula Rod System in ankle fractures in the elderly[J].Foot Ankle Surg,2017,19(24):1-10.
[13]杨云,方跃,钟刚,等.弹性髓内针与钢板螺钉治疗腓骨干骨折的比较研究[J].中华创伤骨科杂志,2018,20(2):172-176.
[14]Wang Q,Xu HG,Zhang YC,et al.Elastic nails for fibular fracture in adult tibiofibular fractures[J].Int J Clin Exp Med,2015,8(6):10086-10090.