陈旧性踝关节骨折的治疗

Treatment of Old Fractures of the Ankle Joint

作者报告了陈旧性踝关节骨折并距骨移位和下胫腓关节分离３５例，行踝关节间隙水平外踝横行截骨、复位。对２７例平均随访２８个月，优良率为８９％，尚可１１％。其中男１０例，女１７例。年龄１７～５８岁。２７例中外踝骨折４例，双踝骨折１６例，三踝骨折３例。外踝骨折均为ＷｅｂｅｒＢ型。下胫腓关节分离４例。病程２个月～３年４个月，平均１６个月。术前Ｘ线片均无明显的损伤性关节炎表现。作者认为影像学上如无明显的损伤性关节炎表现都应积极手术治疗，不应受年龄及病程长短的限制。外踝截骨水平不宜高于踝关节间隙，否则外踝及距骨复位不易成功。内踝及距骨间瘢痕要彻底切除，使距骨复位不受阻碍。采用横行水平截骨使内移、内旋复位方便自如，截骨面接触良好，愈合快。内固定要简单易取除，以便早日功能锻炼，恢复踝关节功能。

Thirtyfive cases of old fractures of the ankle, with displacement of talus and separation of distal tibiafibula joint were treated with horizontal lateral malleolus osteotomy and reduction; 27 cases were available for followup study. There were 4 lateral malleolus fractures, 16 bimalleolar fractures and 3 trimalleolar fractures and 4 distal tibiafibular joint separations. All of the lateral malleolus fractures belonged to Weber B. The ages ranged from 17 to 58 years. There were 10 males and 17 females. The duration from injury to surgery ranged from 2 months to 3 year and 4 months,with an average of 16 months. No obvious traumatic arthritis was found on Xray film before operation.The average followup of 27 cases was 28 months and the excellent results were obtained in 89% of the patients, and fair in 11%.The authors considered that the opeative treatment may be a better choice if there were no obvious traumatic arthritis. The ages and the duration of lesion were not important factors for the surgical decision. Lateral malleolus osteotomy shouldn't be higher than the joint space of ankle, otherwise lateral malleolus and talus were difficult to be reduced. Cicatrices between medial malleolus and talus must be removed thoroughly so that the reduction of talus would not be hindered. The authors concluded that if horizontal osteotomy was chosen, the reduction can be performed easily. As simple as possible internal fixation should be used, so that they can be removed easily and is beneficial for early functional recovely.