三踝骨折分型与手术体位选择的关系及疗效分析

Operation position selection according to types of trimalleolus fractures

目的探讨根据三踝骨折分型选择手术体位的临床疗效。方法选取2007年1月-2010年1月29例三踝骨折患者作为病例组，行切开复位内固定术，其中男21例，女8例；年龄20～67岁，平均41岁。根据Lauge—Hansen分型：旋前外旋型9例，旋前外展型1例，旋后外旋型17例，旋后内收型2例。患者均根据骨折分型并结合CT片选择相应的体位，其中单纯俯卧位10例，侧俯卧位改仰卧位15例，单纯仰卧位4例。对照组29例，其中旋前外旋型9例，旋前外展型1例，旋后外旋型17例，旋后内收型2例。全部患者采用先仰卧位再改为俯卧位的手术体位。比较两组手术时间、术中出血量、切口愈合时间以及骨折愈合时间等。结果病例组29例患者均获随访，随访时间5～36个月，平均21个月。骨折复位效果满足：（1）恢复了踝穴的正常解剖关系；（2）踝关节负重面与小腿纵轴线垂直；（3）踝关节面平滑。平均手术时间：病例组102．5min，对照组156．8min。平均出血量：病例组145．6ml，对照组270．3ml。平均切口愈合时间：病例组14．6d，对照组19．3d（P〈0．05）。骨折平均愈合时间：病例组14．2周，对照组15．4周（P〉0．05）。结论对于三踝骨折，根据不同的骨折类型选择相应的手术体位，可以节省手术时间，减少失血量，缩短切口愈合时间。

Objective To evaluate the curative efficacy of appropriate operation positions selected according to different fracture types of trimalleolus fractures. Methods Twenty-nine patients of trimalleolus fractures were performed open reduction and internal fixation from January 2007 to January 2010 （ the study group）. There were 21 males and 8 females at average age of 41 years （range, 20-67 years）. According to Lauge-Hansen typing, there were nine patients with pronation-external rotation type, one with pronation-abduetion type, 17 with supination-external rotation type and two with supination- adduction type. Operation positions were selected according to fracture types and CT： prone position was selected in 10 patients, lateral to supine position in 15 and supine position in four. In the control group, there were 29 patients including nine patients with pronation-external rotation type, 17 with supination-external rotation type, two with supination- adduction type and one with pronation-abduction type. All the patients were in supine to prone position. The operation time, blood loss, wound healing time and fracture healing time were compared in the two groups. Results All the patients in the study group were followed up for mean duration of 21 months （range, 5-36 months）. Satisfactory fracture reduction was obtained： the fractures reached anatomy reduction in radiological manifestation ; weight bearing surface of the ankle was perpendicular to the longitudinal axis of lower leg; the surface of the ankle was smooth. The operation time was 102.5 minutes in the study group and 156.8 min in the control group. The mean operation time, mean blood loss and mean wound healing time were 102.5 min, 145.6 ml, 14.6 days respectively in the study group, and were 156.8 min, 270.3 ml and 19.3 days in the control group, with significant difference （P 〈0.05 ）. The fracture healing time was 14.2 weeks in the study group and 15.4 weeks in the control group, with no statistical difference （ P 〉 O. 05 ）. Conclusion Selection of appropriate operation positions according to different fracture types of trimalleolus fractures is contributive to shorter operation time, less blood loss and shorter fracture healing time.