摘要目的 比较空心螺钉和“L”形钢板治疗胫骨中下1/3螺旋形骨折合并后踝骨折的疗效. 方法 采用回顾性病例对照研究分析2010年1月-2017年1月收治的73例胫骨中下1/3螺旋形骨折合并后踝骨折患者临床资料,其中男47例,女26例;年龄23 ～70岁,平均38.5岁.根据后踝骨折固定方法进行分组,其中空心螺钉内固定治疗38例(空心钉组),“L”形钢板内固定治疗35例(钢板组).胫骨中下1/3螺旋形骨折均采用内侧解剖钢板内固定治疗.记录手术时间、术中出血量及术后感染情况,观察骨折愈合情况及并发症发生情况.采用Baird-Jackson评分标准评价踝关节功能. 结果 术中两组手术时间和出血量比较,差异均无统计学意义(P＞0.05).两组患者中71例获得随访,随访时间6～18个月,平均15.8个月.空心钉组2例失访.两组术后伤口愈合良好,未出现伤口感染征象.骨折均愈合良好,无骨折延迟愈合或不愈合,两组骨折愈合时间差异无统计学意义(P＞0.05).随访中未发现后踝骨折复位明显丢失.钢板组有1例术后躅趾出现垂状趾畸形,可能与(母)长屈肌肌肉痉挛有关,且在钢板取出后病情好转不明显.末次随访时,Baird-Jackson评分:空心螺钉组优18例,良13例,可4例,差1例,优良率82％;钢板组优17例,良13例,可4例,差1例,优良率86％ (P ＞0.05). 结论 空心螺钉和“L”形钢板治疗胫骨中下1/3螺旋形骨折合并后踝骨折的临床疗效无明显差异,均是稳定固定,均可减少髋关节功能异常发生及提高患者生活质量,是治疗后踝骨折的良好方法.

abstractsObjective To compare the clinical efficacy of hollow screws and "L" type plate for the treatment of middle and lower 1/3 spiral fracture of tibia combined with posterior malleolar fracture.Methods A retrospective case control study was performed on the clinical data of 73 patients with middle and lower 1/3 spiral fracture of tibia combined with posterior malleolar fracture treated from January 2010to January 2017.There were 47 males and 26 females,with the mean age of 38.5 years (range,23-70 years).According to the posterior malleolus fixation method,38 cases adopted the internal fixation with three hollow screws (screw group),and 35 cases with" L" type plate fixation (plate group).The middle and lower 1/3 spiral fracture of tibia were treated with medial anatomical plate internal fixation.The intraoperative blood loss,operation time,infection,fracture healing time,and complications were recorded.The Baird-Jackson score was used to evaluate the ankle joint function.Results There were no significant differences in the blood loss and operation time between the two groups (P ＞ 0.05).A total of 71 patients were followed up for 6-18 months (mean,15.8 months).Two cases in the screw group were lost to follow up.The wounds healed well after operation in two groups,and no signs of wound infection were found.All fractures healed well without delayed union or nonunion.There was no significant difference in fracture healing time between the two groups (P ＞ 0.05).No obvious reduction loss in posterior ankle fracture was found during follow-up.In the plate group,one patient was seen vertical shape toe deformity after operation,which might be related to muscle spasm of flexor hallucis longus,and the condition was not improved after removing the plate.At the last follow up,ankle joint function was evaluated according to the Baird-Jackson scoring system:in the screw group,18 cases were excellent,13 cases were good,four cases were allowed to pass,and one case was poor,with the excellent and good rate of 82％;in the plate group,17 cases were excellent,13 cases were good,four cases were allowed to pass,and one case was poor,with the excellent and good rate of 86％ (P ＞ 0.05).Conclusion The clinical efficacy of hollow screws and "L" type plate is not significantly different,both of which can provide rigid fixation,reduce the incidence of hip dysfunction and improve quality of life of patients with middle and lower 1/3 spiral fracture of tibia combined with posterior malleolar fracture.