Dupuytren骨折的诊断和治疗

Diagnosis and treatment of Dupuytren fracture

目的：探讨Dupuytren骨折的诊断和治疗.方法：20例患者中男14例,女6例;平均年龄32.8岁（19～65岁）.左踝12例,右踝8例.扭伤14例,坠落伤3例,车祸伤3例.开放伤5例,闭合伤15例.明确诊断时间：2 h内13例,3 d内5例,7 d内2例.13例通过踝关节正侧位X线片确诊,5例在加摄小腿全长正侧位X线片后确诊,2例在行双踝外翻应力X线片对照检查后确诊.20例确诊患者均行腓骨解剖复位半管形钢板内固定,10例伴内踝骨折者在内踝复位后用松质骨螺钉或张力带固定,14例固定下胫腓联合.结果：通过对17例患者进行了1.3～6年（平均3.1年）的随访,根据Meyer和Kumler的踝关节功能评价标准,17例中优10例,良4例,一般2例,差1例（此例患者在2个月后踝关节正侧位X线片显示内踝踝穴增宽）.结论：对于Dupuytren骨折,早期准确的诊断和正确的外科治疗是恢复踝关节良好功能的关键.

Objective：To study the diagnosis and treatment of Dupuytren fracture. Methods： There were 20 patients（ 14 male ,6 female）with an average age of 32. 8 years （range from 19-65 years）. Left ankle 12 cases and right ankle 8 cases;strain in 14 cases,falling injury in 3 ,traffic accident in 3 ;open injury in 5 and close injury in 15. The time from injury to diagnosis： 13 cases in 2 hours,5 in 3 days,2 in 7 days. 13 cases were diagnosed by anterior and lateral X-ray,5 cases were diagnosed by full tibiofibular anterior and lateral X-ray, 2 cases were diagnosed by contrast the bimalleolar stressing X-ray. All patients were treated with fibula open reducted anatomically and fixed by 1/3 tubular plate. 10 cases with internal malleolar fracture were fixed by lag screw or tension band after reduction,the syndesmosis in 14 cases were fixed. Results：17 cases were followedup from 1.3 to 6 years with an average of 3. 1 years. The clinical effect were evaluated according to the criteria of Meyer and Kumler, the excellent in 10 cases, good in 4, fair in 2, poor in 1 （ after 2 months, the patient＇ s ankle cave were lenient in anterior and lateral X-ray）. Conclusion：Earlier, accurate diagnosis and surgical treatment for Dupuytren fracture is the key to recovery function of ankle joint.