摘要
目的总结旋前、后外旋型(Ⅳ度)三踝骨折切开复位内固定的手术方法和疗效。方法1996年3月～2002年10月,对48例旋前、后外旋型(Ⅳ度)三踝骨折行切开复位内固定术,男27例,女21例;年龄17～85岁,平均42.8岁。根据Lauge-Hansen分类,旋前外旋型Ⅳ度三踝骨折20例,旋后外旋Ⅳ度三踝骨折28例。受伤距手术时间2h～21d。内侧采用标准内踝切口显露内踝骨折,外侧采用腓骨后缘纵行切口显露外踝骨折。如需行后踝骨折处理,则将内踝的切口延长,外侧采用经腓骨的Gatelli-er-Chastang手术入路同时切开显露内、外及后踝。整复固定的顺序是后踝、内踝、外踝和下胫腓联合。骨折复位固定完成后,行踝部正侧位及踝榫(Mortise)位X线检查。满意复位的标准为:(1)踝榫的正常关系恢复,(2)踝的负重排列与下肢纵轴成直角,(3)关节面的外形轮廓光滑。结果全部患者均获得随访,随访时间6～36个月,平均13个月。骨折愈合时间为12～16周。随访时疗效评定根据Baird-Jackson评分系统进行评定:优26例,良15例,可5例,差2例;优良率为85.4%。术后未发生感染、骨不连、骨折畸形愈合等并发症,但发生1例下胫腓三皮质固定螺钉断裂。结论踝关节的解剖复位可获得最佳的临床结果,采用切开复位内固定术治疗三踝骨折可保证踝关节获得解剖复位,最大限度地恢复踝关?
Objective To evaluate the surgical techniques of open reduction and internal fixation and its clinical results of trimalleolar fractures retrospectively. Methods Between March 1996 and October 2002, 48 consecutive patients, including 27 males and 21 females with an average age of 42.8 years, were treated for trimalleolar fractures. According to the system of Lauge-Hansen, the fractures were classified as pronation-external rotation(grade Ⅳ) injury in 20 cases, and supination-external rotation(grade Ⅳ) in 28 cases. The time from injury to operation was from 2 hours to 21 days. The operation was delayed due to associated injury, skin conditions and so on, and then the patients were manipulated primarily and immobilized with a posterior plaster splint. The medial, lateral and posterior malleolus were exposed by anteromedial and Gatellier-Chastang approaches. The reduction and internal fixation started with the posterior, then the medial and the lateral malleolus and distal tibiofibular syndesmosis in sequence. The ankles were immobilized with plaster in neutral position and elevated. All patients were assessed with Baird and Jackson ankle scoring system based on pain, instability, walking ability, movement and radiological manifestations. Results The follow-up period varied from 6 to 36 months with an average of 13 months. The rates of clinical result were excellent in 26, good in 15, fair in 5 and poor in 2 respectively. The total rate of good to excellent results was 85.4%. There were no local complication, malunion and nonunion of the fractures and the deformity of the ankle. However, the inserted screw to distal tibiofibular syndesmosis was broken in one case. Conclusion Trimalleolar fractures require open reduction and internal fixation more often, especially while the fragment of posterior malleous is so large that it should be anatomically reduced and immobilized with internal fixation. It can ensure anatomical joint restoration and union for the ankle trimalleolar fractures, only by achieving most satisfied kinematics of the ankle joint.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2004年第1期3-6,共4页
Chinese Journal of Orthopaedics
