后踝关节面解剖复位在踝关节骨折手术治疗中的临床意义.doc

后踝关节面解剖复位和内固定在踝关节骨折手术治疗中的临床意义
施保华沈决心谭晚明上海市崇明县堡镇人民医院骨科202157
【摘要】目的总结治疗踝关节骨折中后踝骨折的手术方法和治疗效果。方法自2005年3月-2010年6月，手术治疗后踝骨折54例。男36例，女18例；根据CT分类Ⅰ型36例，Ⅱ型10例，Ⅲ型8例。应用改良的Baird-Jackson评分系统对其术后疗效进行评定，并将骨折类型、骨折固定方法、术后功能锻炼时间与最终功能的关系进行分析。结果随访时间为6-36个月，平均18个月。54例疗效为：优29例，良18例，可5例，差2例，优良率为87.03%。除4例长时间行走有轻微疼痛外，其余患者均无疼痛。结论手术治疗后踝骨折可取得满意的骨折复位和临床疗效，复位的质量与疗效密切相关，判断骨折类型和选择固定方法对于提高复位质量，改善远期疗效十分重要。
【关键词】后踝骨折；解剖复位；内固定；踝关节骨折手术治疗
Theclinicalsignificanceofanatomicreductionandinternalfixationofposteriormalleolarfractureinanklefracturesurgicaltreatment
SHIBaohuaSHENJuexin
DepartmentofOrthopedics,ThePeople’sHospitalofBaoZhen;ChongMing;ShangHai;202157
AbstractObjectiveToevaluatetheclinicalsignificanceofanatomicreductionandinternalfixationofposteriormalleolarfractureinanklefracturesurgicaltreatmentMethodsFifty-fourpatientswithposteriormalleolarfractureweretreatedwithanatomicreductionandinternalfixationfromMarch2005toJune2010.Thepatientsgroupsconsistedof36malesand18females.AccordingtoCTscanclassification,thegroupwasmadeupof36typeⅠcases,10typeⅡand8typeⅢcases.AllpatientswereevaluatedwithmodifiedBaird-Jacksonscoringsystem.
Therelationshipbetweenfinalresultandfracturepattern,fixationmethods,thetimeofexerciseinitiationfittedoperationwereanalyzedrespectively.ResultsThefollowed-upperiodvariedfrom6monthsto36months,withanaverageof18months.Thenumberofpatientswhoseresultwasexcellent,good,fairandpoorwasrespective29,18,5and2.Thetotalpercentageofgoodtoexcellentclinicalresultwas87.03%.Therewere4patientswhohadonlyslightpainafterlongtimewalking,theremainderpatientswerecompletedwithnopain.ConclusionOperativetreatmentmayprovidesatisfactoryfractureanatomicreductionandinternalfixationforposteriormalleolarfracture.Correctfracturepatternestimationandproperinternalfixationwereofimportanttoachieveandimprovereductionquality,andtoamelioratebetterlongtermresults.
KeywordsFracturesofPosteriormalleolus(FPM)AnatomicreductionInternalfixationAnklefracturesurgicaltreatment
在所有踝关节骨折中，累及后踝的骨折占14％～44%[1]。后踝骨折常伴发内外踝骨折，单独发生的后踝骨折非常罕见[2]。踝关