侧卧屈膝牵引器辅助髓内钉钢板固定胫腓骨骨折

Reduction and internal fixation with plate and intermedullary nail using a distractor in lateral position with knee flexion for tibiofibular fractures

摘要:

[目的] 介绍侧卧屈膝位牵引复位辅助髓内钉钢板固定胫腓骨骨折的手术技术和初步临床效果。[方法] 2020 年 6 月—2021 年 6 月对 46 例胫腓骨骨折患者采用侧卧屈膝位牵引复位辅助髓内钉钢板治疗。患者侧卧屈膝位，患肢平行置于健侧肢体上方，分别于胫骨平台及跟骨钻入克氏针，安装骨牵引复位器，牵引复位骨折，腓骨小切口 MIPPO 技术置入金属板内固定。取膝前髌下正中纵行切口，劈开髌韧带，屈曲膝关节扩髓，置入髓内钉。[结果]所有手术顺利完成，无神经、血管损伤等严重并发症，手术时间平均 （118.5±2.0） min，术中出血量平均 （120.8±8.1） ml，透视时间 （20.1±3.2） s。患者平均随访 （12.3±2.2）个月，骨折临床愈合时间（24.1±1.8）周，末次随访时美国足踝外科协会踝-后足评分为（92.8±2.6）分。[结论]侧卧屈膝位牵引复位辅助髓内钉钢板治疗胫腓骨骨折，复位快速，操作便捷，术中透视方便，降低术中复位丢失、缩短手术时间。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of reduction and internal fixation with plate and intermedullary nail using a distractor in lateral position with knee flexion for tibiofibular fractures. [Methods] From June 2020 to June 2021, 46 patients received the abovesaid surgical treatment for tibiofibular fractures. The patient was placed in the lateral decubitus posi- tion with knee flexion in 90 degrees and the affected limb parallel to the healthy limb. Schanze pins were inserted in the tibial plateau and calcaneus respectively, and then the shelf-developed retractor was attached with the pins applying axial distraction force to reduce the frac- tures and maintain the reduction. Under this condition, the fibular fractures were fixed with a plate by MIPPO technique through small inci- sions, subsequently, the tibial fractures were fastened with an interlocking intermedullary nail inserted through the inferior patellar ap- proach. [Results] All the patients had operations conducted successfully, without neurovascular injury or other serious complications, while with operation time of (118.5±2.0) min, intraoperative blood loss of (120.8±8.1) ml, and X-ray exposure time of (20.1±3.2) s. The patients were followed up for (12.3±2.2) months on a mean, and got clinical healing of the fractures in (24.1±1.8) weeks postoperatively, and were marked American Society for Foot and Ankle Surgery's ankle-hindfoot score of (92.8±2.6) at the latest follow-up. [Conclusion] The reduc- tion and internal fixation with plate and intermedullary nail using self-developed distractor in lateral kneeling position for tibiofibular frac- tures do facilitate surgical operation, intraoperative fluoroscopy to achieve rapid facture reduction, with advantages of reducing the loss of in- traoperative reduction and shortening the operation time.