探究主辅钢板内固定技术能否为胫骨中下1/3骨折提供一个可选择的治疗方案。

回顾性收集山西医科大学第二医院骨科单一团队于2015年6月至2021年7月期间收治的胫骨中下1/3骨折患者40例，AO分型为42A（11例）、42B（5例）、42C（24例）。男性33例，女性7例；左侧21例，右侧19例；年龄18~67岁，平均年龄为（43.4±14.3）岁。所有患者经由同一团队以同一方法完成主辅钢板手术治疗，术后指导患者康复锻炼，出院后定期门诊复查，观察并记录骨折对位、对线和骨折愈合情况，记录患者并发症以及不良反应，评价踝关节功能情况，随访患者直至骨折完全愈合。

35例患者得到随访，失随访患者5例，失访率12.5%。随访时间为4~33月。骨折愈合时间为12~20周，中位数为16（14，18）周。踝-后足AOFAS评分显示该方法治疗胫骨中下1/3骨折优良率为97.1%。其中1例患者外踝部皮肤出现轻度感染破溃，经过换药和抗炎治疗后伤口愈合。1例Gustilo I型的患者胫前皮肤出现破溃，螺钉尾帽外露，经过换药缝合后伤口愈合。1例患者出现胫骨轻度外翻畸形（外翻角度约为8°），末次随访时，步态正常，X线片显示骨折愈合，患者可无痛行走。

在胫骨中下1/3骨折的治疗中，主辅钢板技术提供了坚实的内固定，有效防止了骨折断端术后移位，患者能更早的进行康复锻炼，减少了踝关节僵硬等并发症；降低了骨折延迟愈合、不愈合的发生率；取得了良好的临床效果。

To explore whether the treatment with main and auxiliary plates can provide an alternative treatment for the middle and lower 1/3 tibial fractures.

Forty patients with mid-lower 1/3 tibial fractures admitted to the Second Hospital of Shanxi Medical University Orthopedics single team between June 2015 and July 2021 were retrospectively collected, with AO classification of 42A (11 cases), 42B (5 cases) and 42C (24 cases). There were 33 males and 7 females; 21 left-sided cases and 19 right-sided cases; ages ranged from 18 to 67 years, with a mean age of (43.4±14.3) years. All patients were treated with main and auxiliary plates in the same way by the same team. Post-operative rehabilitation exercises were given to the patients and regular follow-ups were carried out after discharge. The fracture alignment and fracture healing were observed and recorded, complications and adverse effects were recorded. The ankle joint function was analyzed with the AOFAS score of the ankle. Patients were followed up until the fracture healed completely.

Thirty-five patients were followed up and 5 patients were lost. The follow-up period was 4 to 33 months. The fracture healing time was 12 to 20 weeks, the median was 16 (14, 18) weeks. The AOFAS score of ankle-hindfoot showed an excellent rate of 97.1% for the treatment of mid-lower 1/3 tibial fractures. One patient had a mildly infected skin ulceration of the lateral malleolus and the wound healed after dressing changes and anti-inflammatory treatment. One patient with Gustilo type I tibial fracture accompanied with ulceration of anterior tibial skin and exposed internalfixation, wound healed after dressing changes and sutures. One patient got tibial valgus deformity (valgus angle approximately 8°) which has no serious effect on walking. Importantly, in their last follow-ups, the fracture position was good, and the X-ray showed that the fracture healed, and the patients could walk without pain and support.

In the treatment of the middle and lower 1/3 tibial fractures, the main and auxiliary plates technique provides a solid internal fixation, effectively preventing the displacement of the fracture end so the patients can carry out rehabilitation exercises earlier and complications such as ankle stiffness are reduced. Meanwhile, it reduces the incidence of delayed fracture healing and nonunion. It has achieved good clinical results.