开放性踝关节骨折脱位的外科治疗

Surgical treatment of open fracture and dislocation of ankle joint

目的探讨开放性踝关节骨折脱位的损伤特点和外科手术方法及疗效。方法2000年4月～2007年3月,手术治疗随访资料完整的开放性踝关节骨折及脱位41例。男性25例,女性16例;年龄23～69岁,平均38.5岁。开放伤口按Gustilo-Anderson分度:Ⅰ度4例,Ⅱ度21例,ⅢA度9例,ⅢB度5例,ⅢC度2例。冲洗伤口及彻底清创后,根据伤口情况和骨折类型、粉碎移位程度,采用克氏针、螺钉或钢钣固定。结果41例获随访12～36个月,平均18.7个月。5例伤口浅表感染,经对症处理后痊愈;3例伤口皮缘坏死,行二期植皮;其余伤口均Ⅰ期愈合。骨折愈合时间为12～24周。于术后1年完整取出内固定。术后患者踝关节活动范围背伸21.3～25.8°,屈曲35.8～43.5°。按照美国足踝外科评分系统评定疗效,优24例,良11例,可4例,差2例。优良率85.4%。结论及时冲洗伤口及彻底清创,恢复踝关节力线,修复重建踝关节骨折及脱位,是获得满意疗效的基础。

【Objective】To explore the injury features of open fracture and dislocation of ankle joint, and the operative technique and effect. 【Methods】From April 2000 to March 2007, 41 cases with fractured and dislocated ankle joint were operated on. There were 25 males and 16 females with the average age of 38.5 years （ranging from 23 years to 69 years）. According to the Gustilo-Anderson standard, 4 cases were divided into GustiloⅠ, 21 cases Gustilo II, 9 cases Gustilo Ⅲ A and 5 cases Gustilo Ⅲ B and 2 case Gustilo Ⅲ C. After the wounds were thoroughly irrigated and debrided, fixation with screws, plates or K-wires was performed according to wound condition and fractures＇ classification, the degree of comminution and displacement of fracture. 【Results】All cases were followed up for the average time of 18.7 months （from 12 months to 36 months）. All incisions healed at the first stage except 8 cases in which 5 cases had delayed union because of superficial infection which was then cured by ointment and 3 cases of superficial skin necrosis treated with skin-grafting. The time of bone union was from 12 weeks to 24 weeks. The fixation objects were taken out 1 year after the operation. The postoperative function of malleolus extended from 21.3o to 25.8o and flection from 35.8o to 43.5o. Assessed by the American Orthopaedic Foot and Ankle Society Clinical Rating Scales, 24 cases were excellent, 11 good, 4 fair, 2 poor, and the choiceness rate reached 85.4 %. 【Conclusion】Thorough irrigation and debridement of wounds in time, the restoration of the axial alignment of ankle joint, repair and reconstruction of the fracture and dislocation are important to attain satisfactory effect for the treatment of open fracture and dislocation of ankle joint.