中国修复重建外科杂志

中国修复重建外科杂志

踝关节骨折的手术治疗

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探讨踝关节骨折切开复位内固定方法和治疗效果。 方法 2001 年3 月- 2006 年1 月,采用手术治疗踝关节骨折85 例。男65 例,女20 例;年龄17 ~ 65 岁,平均36.5 岁。根据Lauge-Hansen 分型,旋前外旋型Ⅱ度12 例、Ⅳ度9 例,旋后外旋型Ⅱ度34 例、Ⅳ度16 例,旋后内收型Ⅱ度8 例,旋前外展型6 例。合并胫腓下联合分离10例。闭合性骨折21 例,伤后予以简单手法复位石膏托固定后2 h ~ 10 d 手术;开放性骨折64 例,急诊清创同时行骨折复位内固定。 结果 85 例术后切口Ⅰ期愈合。患者均获随访6 ~ 36 个月,平均10 个月。术后未发生骨不连、畸形愈合、胫腓下联合处螺钉断裂等并发症。临床疗效按Baird-Jackson 踝关节评分评定,优53 例,良23 例,可6 例,差3 例,优良率89.4%。骨折愈合时间平均150 d。 结论 手术治疗踝关节骨折可取得满意的临床疗效,对骨折类型的准确判断及正确选择固定方法对于提高复位质量、改善远期疗效具有重要意义。

To evaluate the surgical techniques of open reduction and internal fixation performed for ankle fracture retrospectively and the corresponding cl inical outcomes. Methods From March 2001 to January 2006, 242 patients with ankle fracture were treated. A total of 85 patients with complete cl inical data were analyzed. According to the Lauge-Hansen classification system, the fractures were classified into pronation-external rotation(grade II) in 12 cases and grade IV in 9 cases, supination-external rotation(grade II) in 34 cases and grade IV in 16 cases, supination-adduction (grade II) in 8 cases, and pronation-abduction in 6 cases.The reduction and internal fixation started with lateral malleolus, then medial
malleolus and posterior malleolus, and distal tibiofibular syndesmosis in sequence. Among 10 cases, 5 of the distal tibiofibular syndesmosis were fixed with one screw through 3 layers of bone cortexes. All cases were auxil iarily fixed with plaster pad for 4 to 6 weeks after operation. Results The follow-up period varied from 6 to 36 months, with an average of 10 months. There were no local compl ications such as malunion or nonunion of the fractures and deformity of the ankle. The inserted screw to distal tibiofibular syndesmosis was not broken. The patients were evaluated with Baird-Jackson scoring system.The numbers of the patients who had excellent, good, fair and poor results were 53, 23, 6, 3, respectively.The excellent and good rate was 89.4 %. Conclusion Operative treatment may provide satisfactory cl innical outcomes for ankle fracture.Proper internal fixation and correct fracture pattern estimation are of importance to achieve and gain better long-term results.

关键词: 踝关节; 骨折; 内固定

Key words: Ankle joint; Fracture; Internal fixation

引用本文: 马健全,李杨,王志强. 踝关节骨折的手术治疗. 中国修复重建外科杂志, 2008, 22(4): 456-458. doi: 复制

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