踝关节骨折的手术治疗.pdf

·456·ChineseJournalofReparativeandReconstructiveSurgery,April2008,Vol.22,No.4

踝关节骨折的手术治疗

马健全 李杨 王志强

【摘 要】  目的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2h～10d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150d。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。
【关键词】踝关节骨折内固定
中图分类号： R687.43R683.42文献标志码：A

SURGICALTECHNIQUESOFOPENREDUCTIONANDINTERNALFIXATIONFORANKLEFRACTURE/MA
Jianquan,LIYang,WANGZhiqiang.DepartmentofOrthopedics,theAffiliatedHospitalofMedicalCollegeofChinesePeople’s
ArmedPoliceForce,Tianjin,300162,P.R.China.Correspondingauthor:MAJianquan,E-mail:[e-mail]
【Abstract】  ObjectiveToevaluatethesurgicaltechniquesofopenreductionandinternalfixationperformedfor
anklefractureretrospectivelyandthecorrespondingclinicaloutcomes.MethodsFromMarch2001toJanuary2006,242
patientswithanklefractureweretreated.Atotalof85patientswithcompleteclinicaldatawereanalyzed.Accordingtothe
Lauge-Hansenclassificationsystem,thefractureswereclassifiedintopronation-externalrotation(gradeII)in12casesand
gradeIVin9cases,supination-externalrotation(gradeII)in34casesandgradeIVin16cases,supination-adduction(gradeII)
in8cases,andpronation-abductionin6cases.Thereductionandinternalfixationstartedwithlateralmalleolus,thenmedial
malleolusandposteriormalleolus,anddistaltibiofibularsyndesmosisinsequence.Among10cases,5ofthedistaltibiofibular
syndesmosiswerefixedwithonescrewthrough3layersofbonecortexes.Allcaseswereauxiliarilyfixedwithplasterpadfor
4to6weeksafteroperation.ResultsThefollow-upperiodvariedfrom6to36months,withanaverageof10months.
Therewerenolocalcomplicationssuchasmalunionornonunionofthefracturesanddeformityoftheankle.Theinserted
screwtodistaltibiofibularsyndesmosiswasnotbroken.ThepatientswereevaluatedwithBaird-Jac