髓内钉治疗胫腓骨中下1/3骨折腓骨固定与否的疗效比较

《寰枢椎脱位中西医结合诊疗指南》由中国中西医结合学会脊柱医学专业委员会遵照循证医学原则和专家共识制定,为骨科医师提供AAD临床诊疗的学术性指导意见。主要内容包括AAD的诊断标准、中医辨证、临床分型、治疗策略和方法。

Curative effect comparison for fixation of fibula or not for the treatment of middle and lower 1/3 fractures of tibia and fibula with intramedullary nail

Objective: To analyze and compare the effect of fibular plate fixation on the treatment of tibial and fibular fractures.Methods: From July 2016 to September 2018,65 cases of middle and lower 1/3 fractures of tibia and fibula were retrospectively analyzed,including 46 males and 19 females,aged 22 to 61 years old. There were 37 cases in fibular fixation group (27 males and 10 females),28 cases in fibular non fixation group (19 males and 9 females). By comparing the operation time,intraoperative bleeding,fracture healing time,ankle rotation and valgus angle,postoperative complications,last follow-up ankle mobility and Baird Jackson score,the operation effect was evaluated.Results: All patients were followed up for 12 to 16 months with an average of(13.67±1.23) months. There were 3 cases of infection of the fibular incision,all of which healed in the first stage without incision dehiscence,and 4 cases of delayed union without nonunion. In the fibula fixation group,the external rotation of ankle joint increased (7.16±1.36)° and the valgus angle increased (3.35±1.16)°;while in the non fixation group,the external rotation increased (10.25±1.58)° and the valgus angle increased (6.46±1.23)° with statistical significance(P<0.05). There was no significant difference in ankle joint activity,fracture healing time and complication rate between two groups(P>0.05);there was significant difference in operation time,intraoperative hemorrhage and Baird Jackson score at the latest follow-up(P<0.05).Conclusion: The fibular plate fixation can prevent the ankle joint from malrotation and valgus deformity,and can obtain better surgical effect and functional prognosis.