弹性外固定器治疗合并下胫腓损伤的踝关节骨折

Treatment of Ankle Fractures with Disruption of the Tibio- Fibular Joint with Elastic External Fixation Device.

对于合并下胫腓损伤的踝关节骨折，需可靠的固定以确保下胫腓韧带在解剖位愈合。保守治疗比较困难，而用骨螺钉和骨栓固定下胫腓将限制下胫腓的生理活动。为此作者设计并使用下胫腓弹性外固定器治疗此类骨折，其特点是直接将作用力施加于胫腓骨下端骨皮质上，由于外固定器由不锈钢材料制成，具有一定的弹性，在恢复下胫腓稳定的同时，不影响下胫腓正常生理活动。此装置设计在承重３０ｋｇ时远端张开，随踝关节背伸及屈曲活动，外固定器远端横径距离改变２～４ｍｍ。同时，利用外固定器的其他部分可将内、外踝复位及固定。自１９８９年开始用此种方法治疗６１例患者，平均随访２年，优良率达９４％。

Fractures of the ankle in adult with disruption of the tibio- fibular joint require adequate stabilization of the ankle mortise to ensure satisfactory healing of the syndesmosis ligaments. Numerous internal fixation techniques for stabilization of syndesmosis have been used, however, most of them do not allow motion between the tibia and fibula during weight- bearing. The authors have designed an ankle external reduct- fixator made of stainless steel which is able to apply forces to the cortices of both distal tibia and fibula to restore thestability of the distal tibio- fibula joint, and to allow the physiological movement of syndesmosis. Biomechanical determination showed that when aload of 30 kg was applied on the device, its distal transverse distance was increased by 2- 4 mm in dorsal flexion of the ankle and then resumed to it original distance in plantar flexion. Since 1989, 61 patients have been treated with this device and followed up for an average of two years, all had bony union without deformity and instability of the ankle, and obtained an overall excellent and good rate in 94% of the cases.