胫骨远端关节外骨折髓内钉治疗术后胫骨旋转对膝关节和踝关节功能影响的研究OA

Objective To investigate the effect of tibial rotation on knee and ankle function following intramedullary nail for extra-articular distal tibial fractures.Methods A retrospective analysis was conducted on 72 patients with extra-articular distal tibial fractures who underwent intramedullary nailing treatment between January 2020 and December 2022,including 38 males and 34 females,aged from 20 to 65 years old with an average of(45.1±11.9)years old;30 cases were on the left side and 42 cases on the right side;35 cases were complicated with ipsilateral fibular fractures,and 37 cases were simple tibial fractures.Patients were divided into a malrotation group(postoperative rotation angle ≥ 10°)and a normal rotation group(postoperative rotation angle＜10°)based on the postoperative tibial rotation angle.The malrotation group comprised 20 patients(9 males,11 females),aged from20 to 65 years with a mean age of(47.2±14.3)years.There were 8 left-sided and 12 right-sided cases.The normal rotation group included 52 patients(29 males,23 females),aged from 25 to 64 years with a mean age of(44.3±10.9)years.There were 22 left-sided and 30 right-sided cases.The postoperative tibial rotation angle,lower extremity functional scale(LEFS),American Orthopedic Foot and Ankle Society(AOFAS)score,knee injury and osteoarthritis outcome score(KOOS),36-item short-form health furvey(SF-36)and the range of motion(ROM)of the knee and ankle joints were recorded and com-pared.Results The 72 patients were followed up for a period ranging from 12 to 48 months,with an average follow-up time of(23.4±9.3)months.At the final follow-up,the mean tibial rotation angle was(8.2±3.8)°,and malrotation(defined as a rotation angle≥10°)was observed in 20 patients.Additionally,35 patients presented with fibula fractures,and the follow-up did not reveal any significant impact on malrotation(P＞0.05).There were no significant differences between malrotation group and normal rotation group(defined as a rotation angle＜10°)regarding function scores and ROM of knee and ankle joint(all P＞0.05).Conclusion Despite high rates of malrotation after extra-articular distal tibial fractures treated with intramedullary nail,the result of mid-term follow-up showed no significantly negative effect on knee and ankle joint functions.However,careful ma-nipulation and precise evaluation should be performed during surgery to avoid the occurrence of malrotation.