脛骨遠位端骨折に対する経皮的スクリュー固定による低侵襲手術

Percutaneous Screw Fixation for Distal Tibial Fractures

　脛骨遠位端骨折の中でも，脛骨の短縮を認めず，骨折線が単純で圧壊を認めない症例では，受傷早期は血腫形成も小さく，小切開で整復し，経皮的スクリュー固定のみで治療が可能である．この適応を満たす5例の脛骨遠位端骨折に経皮的スクリュー固定を行った．平均年齢は29歳，全例閉鎖骨折，AO/分類でB1が2例とC1が3例，受傷から執刀までは平均5.6時間であった．CTを参考にスクリュー挿入レベルと角度を決め，小切開から整復鉗子を滑り込ませX線透視下に整復し，経皮的スクリュー固定を行った．JFFSスコア平均97点と良好な臨床成績であった．

　Distal tibial fractures are one of the most challenging fractures for orthopaedic surgeons because of the presence of comminuted fragments, joint surface defects, and poor soft tissue condition. However, some distal tibial fractures, including fractures not accompanied by shortening and simple fractures, can be treated successfully with minimal open reduction and percutaneous screw fixation in the early period after the injury. We performed percutaneous screw fixation in five cases. The mean age at operation was 29 years old. There were no open fractures. There were two 43-B1 and three 43-C1 fractures according to the AO fracture classification. The mean interval between the injury and surgery was 5.6 hours. We planned the insertion level and angulation of the screws based on the preoperative CT scan, and we performed minimally open reduction with the aid of fluoroscopy and multiple screw fixation. The fractures had healed by a mean period of 8.6 weeks after surgery. The mean JFFS score was 97 points.