踝关节旋后外旋型IV度损伤的手术治疗

Surgical treatment for Grade Ⅳ supination-external rotation ankle injury

目的探讨踝关节旋后外旋型IV度损伤的手术治疗方法和疗效。方法手术治疗踝关节旋后外旋型IV度损伤患者56例。所有病例均有内外踝骨折。49例内踝骨折行金属螺钉固定,7例可吸收螺钉固定。36例出现后踝骨折,其中10例行拉力螺钉固定。外踝行可吸收螺钉固定7例,金属螺钉固定6例,1/3管型钢板固定43例。12例行下胫腓联合固定。术后石膏固定4～6周。结果56例中48例获得随访,随访时间6～18个月,骨折均愈合,愈合时间8～12周。根据Baird-Jackson系统进行疗效评定,优38例,良13例,可4例,优良率为87.7%。结论切开复位内固定治疗踝关节旋后外旋型IV度损伤具有良好的疗效,可最大限度地恢复踝关节的功能。

Objective To summarize the efficacy of surgical approach in treating Ⅳ° supination-external rotation ankle injury. Methods From February 1998 to October 2006, 56 patients with supination-external rotation ankle injury were operated by internal fixation. Forty-nine cases of medial malleolar fracture were operated with screw fixation, 7 cases were operated by absorbable screw. Forth-three of lateral malleolar fracture were fixated by 1/3 tube plate, 7 cases were fixated by absorbable screw, 6 cases were fixated by normal screw. Twelve cases of distal tibiofibular syndesmosis injury were fixated by normal screw. All patients were treated by plaster external fixation for 4-6 weeks after operation. Results 48/56 cases were followed up from 6 to18 months. All patients healed well. The duration for a satisfied healing was 8-12 weeks. The efficacy of different approaches was evaluated based on Baird-Jackson system. Among all patients, the excellent healing rate was 87.7%. Conclusions Internal fixation operation for treating supination-external rotation ankle injury is effective and the function of ankle joint can be totally recovered.