不同固定位置治疗旋后外旋型踝关节骨折的病例对照研究

Case-control study on treatment of ankle fractures of supination-extorsion with different fixed position

目的:探讨Lauge-Hanson Ⅲ、Ⅳ度旋后外旋型踝关节骨折手法整复后的最佳外固定体位。方法:选择2007年1月至2010年6月收治的Lauge-Hanson Ⅲ、Ⅳ度旋后-外旋型踝关节骨折患者46例,随机分为跖屈组(A组)和背伸组(B组),每组23例。A组男14例,女9例;旋后-外旋型Ⅲ度13例,Ⅳ度10例;予手法整复后用"U"形石膏托外固定于内翻内旋跖屈位。B组男15例,女8例;旋后外旋型Ⅲ度14例,Ⅳ度9例;给予手法整复后用"U"形石膏托外固定于内翻内旋背伸位。采用AOFAS踝-后足评分系统评分对两组疗效进行评定。结果:所有患者均获随访,时间6～18个月,平均(12.0±2.2)个月。根据AOFAS踝-后足评分系统评分,A组73～100分,平均(92.58±5.73)分,优16例,良6例,一般1例,差0例;B组AOFAS评分66～100分,平均(85.74±7.56)分,优9例,良7例,一般6例,差1例。A组疗效优于B组。术后A组出现1例长时间行走后患肢踝关节酸痛,晚上轻度肿胀。术后B组出现6例长时间行走后患肢踝关节酸痛,晚上轻度肿胀;1例因后踝骨折块移位较明显,术后患者踝关节僵硬,形成骨性融合。结论:Ⅲ、Ⅳ度旋后-外旋型踝关节骨折手法整复后应外固定于内翻内旋跖屈位。

Objective：To explore the best external fixation posture of ankle fracture of Lauge-Hanson Ⅲdegree and Ⅳdegree supintion-eversion after manipulation. Methods：From January 2007 to June 2010,46 patients with ankle fracture of Lauge-Hanson Ⅲdegree and Ⅳdegree supintion-eversion were selected for this study and were randomly divided into two groups（group A and group B）. There were 14 males and 9 females in group A;and the Lauge-Hanson Ⅲdegree was in 13 cases and Ⅳdegree was in 10 cases;fractures were reduced and fixed with plaster splint of U-shape to the posture with inversion,internal rotation and plantar flexion. There was 15 males and 8 females in group B,and the Lauge-Hanson Ⅲdegree was in 14 case and Ⅳdegree was in 9 cases;fractures were reduced and fixed with plaster splint of U-shape to the posture with inversion,internal rotation and dorsiflexion. The clinical effects were evaluated according to AOFAS scoring system. Results：All the patient were followed up from 6 to 18 months with an average of 12 months. In group A,AOFAS scoring was from 73 to 100 scores with an average of（92.58±5.73） scores,16 cases obtained excellent results,6 good,1 fair;in group B,AOFAS scoring was from 66 to 100 scores with an average of（85.74±7.56） scores,9 cases obtained excellent results,7 good,6 fair and 1 poor. The result of group A was better than that of group B. In group A,1 case occurred with ankle joint ache after long walk and swelling in night. In group B,6 cases also occurred with ankle joint ache after long walk and swelling in night and 1 case with stiffness of joint. So there was obvious difference（P0.05）. Conclusion：For treatment of ankle fracture of Lauge-Hanson Ⅲdegree and Ⅳdegree supintion-eversion,the posture with inversion,internal rotation and plantar flexion exceeds another one with inversion,internal rotation and dorsiflexion with plaster after manipulative reduction.