踝上截骨术治疗踝关节骨折畸形愈合的策略

Therapeutic effect of supramalleolar osteotomy on malunion on ankle joint

目的观察踝上截骨术治疗踝关节骨折畸形愈合的疗效。方法 2005年9月至2008年10月,对15例踝关节骨折畸形愈合患者行踝上截骨术治疗,13例获得完整随访资料。11例行胫骨内侧楔形截骨术即时矫正踝关节内翻,3例在即时矫正内翻的同时行跗管松解术,2例因踝关节内翻畸形愈合合并马蹄畸形在行胫骨圆形穹顶状截骨同时用Ilizarov外固定架下缓慢牵张矫正原始畸形,11例同时行腓骨退旋延长术。用美国骨科足踝外科协会AOFAS踝关节功能评分系统进行评分。结果 13例患者获得12～48个月(平均27.3个月)随访,骨折全部愈合,平均临床愈合时间为14.5周(11～17周),完全负重时间1～19周(平均14.1周)。术后12个月踝关节AOFAS评分为61～95分,平均86.5分,其中优8例,良3例,一般2例,优良率84.6%。1例术后出现足内侧皮肤感觉麻木,经营养神经对症治疗后无缓解。无内固定失效和伤口愈合不良等其他并发症。结论采用踝上截骨术治疗踝关节骨折畸形愈合,可获得满意效果。

Objective To investigate the therapeutic effect of supramalleolar osteotomy for malunion of the ankle joint.Methods 15 patients being admitted to our hospital from September,2005 to octomber,2008,who had suffering from malunions on the ankle joint,were treated with this operation.13 patients of them obtained full informations,11 had got the open wedge-shaped osteotomy and the other 11 of which had treated with the lengthening osteotomy of the fibula. In detail,of the 12 patients,10 had been corrected the varus deformity of the ankle immediately during the operation,3 cases also got the releasing of tarsal tunnel at the same time.Besides this operation,while the other 2 cases which had a severe varus deformity,were also treated with the Ilizarov correct the malformation slowly.The function of the ankles were assemented by the AOFAS scoring system.Results During a mean 27.3（12 to 48 months） months follow-up,all the fracture were healed,the mean time was 14.5 weeks（11-17 weeks）,and the mean time of totally weight-bearing was 14.1weeks（1-19 weeks）.The mean score of the ankle function 12 months after the operation was 86.5,in which, there was 8 excellent,3 good,2 mild,and the ratio of good outcomes was 84.6%.After the operation,all the patients were healed by expectant treatment,while anaesthesia on the inter side of the foot happened to 1 patients,symptom disap- point after 1 week.None of them had no complications with failure of the internal fixation.Conclusion Supramalleolar osteotomy could come to a good outcome for the malunions of the ankle joint.