摘要
目的探讨陈旧性三踝骨折的手术治疗方法。方法2000年1月至2004年1月,手术治疗陈旧性三踝骨折患者58例,男41例,女17例;年龄19～61岁,平均43岁。手术时间为伤后29～76d,平均48d。骨折采用Lauge-Hansen分型,其中旋后外旋型37例,旋前外旋型21例。手术采用前内、前外双侧弧形切口,锐性探查内、外踝原始骨折线,清理骨折断端及踝(,外翻踝关节,直视显露后踝骨折块,清理后踝周围的瘢痕组织,用刀尖探查后踝原始骨折线。清理骨折断端,复位、固定后踝。以骨嵴为标志,恢复外踝的正常长度和力线,并用1/3管型钢板或普通钢板固定。内踝用螺钉或张力带固定。术后10～12周开始部分负重。结果58例均获随访,随访时间18～65个月,平均37个月。2例出现浅表皮缘坏死,4例出现伤口延迟愈合。骨折均一期愈合,愈合时间21～29周,平均25周。2例患者腓骨对位差。6例患者术后X线片显示踝关节间隙变窄,有创伤性关节炎改变,其中2例患者骨折复位良好。根据AOFAS评定标准,踝关节评分优31例,良22例,可5例,优良率91.4%。5例患者疼痛评分在20分,9例患者踝关节背伸活动受限<10°。结论手术治疗伤后76d内三踝骨折,锐性探查原始骨折线,直视下复位后踝骨折块,保留腓骨的正常长度、旋转和力线可以获得良好的复位和临床疗效。
Objective To explore the operative methods of open reduction and fixation for the old trimalleolus fractures. Methods Fifty-eight patients of the old trimalleolus fractures were treated from January 2000 to January 2004. There are 41 males and 17 females with an average age of 43 years （ranged from 19 to 61 years）. The average time of postinjury was 48 days （ranged from 29-76 days）. The fractures were classified by Lauge-Hansen system. Supination-external rotation type in 37 cases. Pronation-external rotation type in 21 cases. The anterior-medial approach and anterior-lateral approach were chosen. Explore the original fracture line of medial and lateral malleolus sharply, resect scar tissue at the fagment and ankle mortise, make the ankle joint valgus, expose the posterior malleolus fragment directly and explore the original fracture line. Reducted and fixed the posterior malleolus. According to the fibular crest, the normal length and alignment were recovered. The fracture was fixed with 1/3 tubular plate or ordinary plate. Medial malleolus was fixed with screw or tention band. The time of partial weight bearing was 10-12 weeks. Results The mean duration of follow up was 37 months （range from 18-65 months）. Superficial skin necrosis was in 2 cases. The wound delayed union in 4 cases. The average time of fracture healing was 25 weeks （range from 21-29 weeks）. The fibula malalignment in 2 cases. 6 cases developed arthrosis. 2 cases in this 6 patients had a good reduction of fractures. The average time of the operation in this 6 patients was 58.5 d after injury. According to the AOFAS scoring system, excellent in 31 cases, good in 22 cases, fair in 5 cases. The total rate of good results was 91.4%. The pain score was up to 20 in 5 cases. 9 cases had restriction of dorsiflexion with less than 10°. Conclusion The excellent reduction and clinical results were obtained by explore the original fracture line sharply, reduct posterior malleolus fragment directly and maintain normal length of the fibula, rotation and alignment for the old trimaleolus fractures which injuried within 76 days.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2006年第6期390-393,共4页
Chinese Journal of Orthopaedics
关键词
踝关节
骨折
外科手术
Ankle joint
Fractures
Surgical procedures, operative
