踝关节骨折后外踝畸形愈合的外科矫形

Lengthening osteotomy of the fibula in treatment of treating lateral malleolar malunon

目的观察腓骨旋转延长截骨术治疗踝关节骨折后外踝畸形愈合的临床疗效。方法自2005年10月至2008年7月，对23例术前诊断为踝部骨折后外踝畸形愈合合并早、中期创伤性关节炎患者行腓骨旋转延长截骨术治疗，采用腓骨斜形或横形截骨，旋转延长后植骨内固定。17例获得完整的随访资料，应用美国骨科足踝外科协会（American Orhopedic FootAnkle Society，AOFAS）踝关节功能评分系统进行评分。结果17例获得12-45个月（平均29．1个月）随访。骨折全部愈合，平均X线愈合时间13．1周（11-16周）。完全负重时间平均为12．1周（11～15周）。术前踝关节AOFAS评分为21-47分（平均29分），术后12个月评分为56-91分（平均81分），优5例，良8例，一般3例，差1例，优良率76．5％。术后1例发生切口皮缘部分坏死，经保守治疗痊愈。2例术后出现足外侧皮肤感觉麻木。2例患者在随访时X线片示关节炎有轻微进展，予以关节腔内注射施沛特，保守治疗后获得较满意的临床效果。无螺钉松动、断裂及内固定失败等其他并发症。结论外踝畸形愈合的踝关节骨折采用腓骨旋转延长截骨术治疗，近期可获得满意效果。

Objective To investigate the therapeutic effect of lengthening and rotational osteotomy of the fibula for lateral malleolar malunion. Methods Twenty-three patients who had suffering from the traumatic arthritis of ankle were due to lateral malleolar malunion treated with lengthening and rotational osteotomy from October 2005 to July 2008. Special radiographs were use to fully detect the extent of shortening and rotation of the fibula. The Lengthening and rotational osteotomy could be conducted with a special compression/distraction device and bone graft. The function of the ankles was evaluated by the American Orthopedic Foot Ankle Society （AOFAS） scoring system. Serial radiographs of the ankle were made to assess the bone healing and changes of posttraumatic osteoarthritis. Results Seventeen of 23 patients were fol- lowed up, with a mean 29.1 mouths （12-45 months）. All the fractures were healed. The mean bone healing time was 13.3 weeks （11-16 weeks） and the mean time of total weight-bearing was 12.1 weeks （11-15 weeks）. The ankle function score had improved from 29 （21-47） preoperatively to 81 （56-91）12 months after the operation. There was 5 in excellent, 8 in good, 3 in mild, 1 in poor, and the rate of good outcomes was 76.5%. After the operation, 1 patient had a skin necrosis around the wound which healed by conservative treatment. A slightly aggravated degeneration of the ankle joint was seen in 2 patients who responded to conservative managements. No failure of the internal fixation was noted in this group. Conclusion The outcomes demonstrate that reconstructive lengthening osteotomy is well worthwhile when there is absent or min- imal osteoarthritic change, regardless the time from the original injury. Lengthening of the fibula is an important step in the treatment of the painful ankle when the fibula become shorter after injury, even when degenerative changes of the joint are already present. The lengthening of the fibula could lead to a good outcome in ankle with lateral malleolar malunion.