三踝骨折的独立分型

An independent classification of trimalleolar fractures

目的:探讨并总结与三踝骨折的独特移位规律相对应的独立分型,改进其复位与固定方法。方法:根据42例三踝骨折患者的术前X线片,根据其有无距骨移位和移位方向以及有无下胫腓分离进行分型,并与传统分型进行比较。结果:三踝骨折可分为稳定型(12例)和非稳定型(30例)。非稳定型又分为3型:Ⅰ型(距骨外脱位型)16例,其中,Ⅰa型(无下胫腓分离的距骨外脱位型)5例;Ⅰb型(有下胫腓分离的距骨外脱位型)11例;Ⅱ型(距骨外后脱位型)8例,其中,Ⅱb型(无下胫腓分离的外后脱位型)5例,Ⅱb型(有下胫腓分离的外后脱位型)3例;Ⅲ型(距骨后脱位型)6例,其中,Ⅲa型(无下胫腓分离的后脱位型)2例,Ⅲb型(有下胫腓分离的后脱位型)4例。结论:根据X线片可对三踝骨折进行独立分型。三踝骨折的独立分型突出了距骨脱位和下胫腓分离两个反映踝关节损伤程度的重要因素,深化了对三踝骨折移位规律的认识,并对其手术适应证的选择、预后判断、手术顺序的安排等均有一定指导意义。

Objective： To investigate an independent classification of trimalleolar fractures according to unique dislocation regularity and to improve the reduction and fixation. Methods： The preoperative radiographs in 42 cases of trimalleolar fractures were studied, and a classification of trimalleolar fractures was concluded according to dislocation of talus and diastasis of distal tibiofibular syndesmosis. The classification of trimalleolar fractures was compared with the traditional classification. Results： Trimalleolar fracture was classified into stable （12 cases） and unstable （30 cases） types. The unstable types was divided into three sub-types： Type Ⅰ （lateral dislocation of talus）in 16 cases, type Ⅱ （lateral-posterior dislocation of talus）in 8 cases and type Ⅲ （posterior dislocation of talus） in 6 cases. Type Ⅰ included type Ⅰ a （without diastasis of distal tibiofibular syndesmosis）in 5 cases and type Ⅰ b（diastasis of distal tibiofibular syndesmosis）in 11 cases. Type Ⅱ included type Ha（without diastasis of distal tibiofibular syndesmosis）in 5 cases and type Ⅱb （diastasis of distal tibiofibular syndesmosis）in 3 cases. TypeⅢ included type Ⅲa（ without diastasis of distal tibiofibular syndesmosis）in 2 cases and type Ⅲb（diastasis of distal tibiofibular syndesmosis）in 4 eases. Conclusion： The independent classification of trimalleolar fractures can be made according to X-ray film. The independent classification of trimalleolar fractures emphasizes two important factors of ankle joint injuries： talus dislocation and distal tibiofibular syndesmosis diastasis. It can facilitate the better understanding of dislocation regularity of trimalleolar fractures and is conducive to selection of indication, prognostic judgement and arrangement of operative order.