踝关节骨折的治疗选择和疗效分析

Analysis on therapeutic selection and efficacy of the fracture of ankle joint

目的 :探讨针对不同的踝关节骨折选择理想的治疗方法。方法 :对 5 0 0例踝关节骨折患者 ,分别采用手法复位夹板固定和切开复位手术治疗。伤后到治疗时间平均 7 5h。随访时间 1～ 8年。结果 :运用踝关节症状与功能评分 (Mazur,1979) ,Weber DenisA型 187例 ,手法治疗优良率 92 % ,手术治疗优良率 95 % ;Weber DenisB型 2 0 7例 ,外踝远端骨折线在踝线下双踝、三踝手法治疗优良率 78% ,手术治疗优良率 86 9% ;外踝远端骨折线在踝线上双踝、三踝手法治疗优良率 5 2 % ,手术治疗优良率85 2 % ;Weber DenisC型 10 6例 ,手法治疗优良率 30 % ,手术治疗优良率 83 9%。结论 :①踝关节骨折中腓骨的解剖复位和下胫腓联合的复位是治疗的关键。②手法复位治疗的成功率与外踝的骨折移位位置和下胫腓联合的完整有很大的关系。③Weber DenisA骨折和Weber DenisB中外踝远端骨折线在踝线下双踝。

Objective:To investigate the selection of ideal therapeutic method for different kinds of ankle joint fracture.Methods:Five hundreds patients with ankle joint fractures had applied different therapeutic methods respectively:Manipulative reduction with splinting or operation of open reduction.The average period between injury and treatment was seven and half hours.The times for following-up were one to eight years.Results:Using score of the ankle's symptoms and function (Mazur,1979),one hundred and eighty-seven patients belong to Weber-Denis A,and the fineness rate of manipulative treatment was 92%,while that of operative treatment was 95%,and there were two hundreds and seven patients belonging to Weber-Denis B,among them,for the patients whose fracture line of the distal part of lateral malleolus were below the ankle line,the fineness rate by the bimalleolar or trimalleolar manipulative treatment was 78%,while the fineness rate of operative treatment was 86.9%,for the patients whose facture line of the distal part of lateral malleolus was above the ankle line,the fineness rate by the bimalleolar or trimalleolar manipulative treatment was 52%,while the fineness rate of operative treatment was 85.2%,and there were one hundred and six cases belonging to Weber-Denis C,among them,the fineness rate of manipulative treatment was 30%,while that of operative treatment was 83.9%.Conclusion:①The important point is the anatomical reduction of fibula and reposition of distal tibiofibular syndesmotic in ankle joint fracture.②The success rate of the manipulative reduction is closely related to the location of the malposition of lateral malleolus fracture and the integrity of distal tibiofibular syndesmotic.③In Weber-Denis A fracture and Weber-Denis B fracture,if the fracture line of the distal part of lateral malleolus is below the ankle line,the bimalleolar or trimalleolar manipulative treatment and operative treatment have no significant different.