踝部损伤机制与后踝骨折块大小及治疗方法选择的关系

Relationship between the cause and length of posterior malleolar fragment and treatment strategies for posterior malleolar fracture in adult patients

目的探讨踝部3种损伤中损伤机制与后踝骨折块大小及治疗方法选择的关系。方法测量2007年7月至2009年6月河北医科大学第三医院创伤急救中心233例单纯踝关节骨折（C损伤）、35例后踝骨折线与胫骨骨折线连续损伤（B损伤）、91例后踝骨折线与胫骨骨折线不连续损伤（A损伤）3种损伤中后踝骨块长度占胫骨远端关节面长度的比例，并对3种损伤中存在的后踝骨折采取不同方法进行治疗，根据可视化疼痛评估量表（VAS评分）比较后踝骨折治疗效果。结果后踝骨折块长度占胫骨远端关节面长度的比例由大到小依次为A损伤、B损伤、C损伤，差异有统计学意义[（34±15）％比（30±9）％比（12±10）％，x^2=187．453，P=0．0000]。12个月时58例A损伤、31例B损伤、167例C损伤患者获得随访，后踝骨折固定与未固定患者的VAS评分之间比较差异均无统计学意义（均P〉0．05）。结论损伤机制不同导致后踝骨折块大小及手术治疗原则不同，但后踝骨折块的解剖复位是获得满意疗效的保证。

Objective To explore the relationship between the causes and length of posterior malleolar fragment and treatment strategies of adult patients with three types of ankle joint injury. Methods The investigators recruited 233 eases of type C injury, 35 eases of type B injury and 91 cases of type A injury. Type A injury referred to simple ankle joint fracture with the involvement of posterior malleolar fragment. Type B injury tibial shaft fracture with ipsilateral ankle joint fracture. And posterior malleolar fracture line was the continuity of tibial shaft fracture line. Type C injury appeared similar to Type B injury, hut tihial and malleolar fracture lines were not continued. The ratio between the length of posterior malleolar articular and the total length of articular surface was calculated in theses three types of injuries in sagital CT scan slice. Different treatment regimens were used to manage the posterior malleolar fractures. And visual analogue score （VAS） was introduced to assess the therapeutic outcomes. Results The ratio between the length of posterior malleolar articular and the total length of articular surface decreased from Type A to Type C （ x^2 = 187. 453, P = 0. 0000）. The ratio was （34 ± 15 ） % for Type A, （ 30 ± 9 ） % for Type B and （ 12 ±10 ） % for Type C. A follow-up study was performed in Type A injury （ n = 58 ）, Type B injury （ n = 31 ） and Type C injury （n = 167） at 12 months. According to VAS score, there was no significant difference between the patients undergoing fixation and not （ all P 〉 0. 05 ）. Conclusion Different causes of posterior malleolar fracture results in different sizes of posterior malleolar fragment and strategies of treatment. The anatomic reduction of posterior malleolar fragment remains a key aspect of achieving satisfactory outcomes in all kinds of injury.