青少年Tillaux骨折合并腓骨远端骨折的手术治疗

Surgical outcome of adolescent Tillaux fracture combined with distal fibular fracture

摘要:

[目的] 探讨青少年 Tillaux 骨折合并腓骨远端骨折的手术治疗效果。[方法] 回顾性分析 2016 年 1 月—2021 年 12 月行切开复位内固定治疗的 17 例青少年 Tillaux 骨折合并腓骨远端骨折患者的的临床资料，评价临床及影像结果。[结果] 17 例患者均顺利手术。随访时间平均 （28.1±11.8） 个月，与术前相比，末次随访时，患者疼痛 VAS 评分 [(9.2±3.6), (1.4±0.3), P＜ 0.001] 显著减少，Lowa 评分 [(26.9±6.7), (94.1±4.9), P＜0.001]、踝关节背伸-跖屈 [(41.6±5.3)°, (73.1±7.3)°, P＜0.001]、内翻-外翻 ROM [(27.4±4.4)°, (64.1±6.0)°, P＜0.001] 显著增加。影像方面，与术前相比，末次随访时患者下胫腓间隙（tibiofibular clear space, TFCS）、胫腓骨重叠（tibiofibular overlap, TFO）、胫腓骨线（tibiofibular line, TFL）、胫骨远端外侧角（anatomic lateral distal tibial angle, aLDTA)、胫骨远端前倾角（anterior distal tibial angle, ADTA）均显著改善（P＜0.05）。[结论]青少年 Tillaux 骨折合并腓骨远端骨折是一种罕见损伤，通过切开复位内固定治疗，实现关节面及骺板的解剖对位，恢复下胫腓联合稳定性，能够获得良好的临床疗效。

Abstract:

[Objective] To investigate the surgical outcomes of Tillaux fracture combined with distal fibular metaphyseal fracture in adolescent. [Methods] A retrospective study was done on 17 adolescents who received open reduction and internal fixation for the Tillaux fracture combined with distal fibular fracture from January 2016 to December 2021. The clinical and imaging documents were evaluated. [Results] All the 17 patients were successfully operated on. Compared with those before operation, the VAS score decreased [(9.2±3.6), (1.4± 0.3), P＜0.001], while Lowa score [(26.9±6.7), (94.1±4.9), P＜0.001], ankle plantar-dorsal flexion range of motion (ROM) [(41.6±5.3)°, (73.1± 7.3)°, P＜0.001] and inversion-eversion ROM [(27.4±4.4)°, (64.1±6.0)°, P＜0.001] significantly increased at the last follow-up. Radiographically, the aLDTA [(73.8±7.2)°, (93.1±4.8)°, P＜0.001], ADTA [(68.7±5.0)°, (81.1±6.8)°, P＜0.001], TFCS [(2.6±1.0) mm, (2.5±0.9) mm, P＜ 0.001], TFO [(3.0±1.1) mm, (3.2±1.1) mm, P＜0.001], TFL [(0.9±0.5) mm, (0.7±0.5) mm, P＜0.001] were improved postoperatively compared to those before surgery. Bony healing of the fractures was observed in all the patients. [Conclusion] Adolescent Tillaux fracture combined with distal fibular fracture is a rare injury. Using open reduction and internal fixation, the anatomical alignment of articular surface and epiphyseal plate can be achieved, and the stability of the distal tibiofibular syndesmosis can be restored, which can achieve good clinical consequences.