伴有下胫腓联合分离的踝关节骨折的治疗

Treatment of Ankle Jiont Fracture with Separationg of Distal Tibiofibular Syndesmosis

目的探讨伴有下胫腓联合分离的踝关节骨折的治疗方法。方法回顾分析我院2003年8月至2007年10月手术治疗伴有下胫腓联合分离的踝关节骨折患者42例,骨折复位后,外踝骨折采用钢板坚强内固定,内踝及后踝采用松质骨钉固定。骨折固定后,下胫腓联合乃不稳定,用1枚皮质骨螺丝钉固定下胫腓联合。术后早期行不负重功能锻炼。术后12周、负重行走前取出固定下胫腓联合的螺丝钉。结果42例患者获得8～25个月的随访,42例中只有16例需要用螺丝钉固定下胫腓联合。根据患者主观感觉、功能检查、X线检查评定疗效,优22例,良13例,可6例,差1例,优良率83.3%,42例患者均未发生下胫腓联合再次分离。结论精确的解剖复位、坚强内固定、早期不负重功能锻炼是提高关节骨折疗效的关键。

Objective To study the treatment method of ankle jiont fracture with separation of distal tibiofibular syndesmosis.Methods From August 2003 to October 2007,we treated 42 patients of ankle jiont fracture with separation of distal tibiofibular syndesmosis. Tnternal and behind fixation with cancellous screws and external fixation with plate and screws were performed on 42 patients. After fixation,it was fixed with a screw on the distal tibiofibular syndesmosis if distal tibiofibular syndesmosis was unstable.All patients had early motion exercise.The screw of distal tibiofibular syndesmosis was taken out at 12 weeks after operation.Results These patients were followed up for 8 to 25 months.Among whom, 16 patients were necessary for fixation with screws on the distal tihiofibular syndesmosis.The curative effects were assessed according to the complaints of the patients,function and radiogram of the ankle jiont：22 excellen,13 good,6 fair, 1 paor.The rate of excellent was 83.3%.42 patients were not recurrence.Conclusion It was found that anatomic reduction,rigid fixation and early motion exercise are important to successful treatment of ankle jiont fracture with separation of distal tibiofibular syndesmosis.