可吸收螺钉在踝关节骨折中的应用

Bioabsorbable screws for the treatment of ankle fractures

目的 探讨可吸收螺钉治疗踝关节骨折的疗效. 方法 2004年6月至2010年12月采用可吸收螺钉治疗16例踝关节骨折患者,男9例,女7例；年龄21～62岁,平均35岁；其中三踝骨折4例（AO分型：B型2例,C型2例）,内外踝骨折8例（AO分型均为B型）,单纯内踝骨折2例,单纯外踝骨折2例（1例为AO分型A型,另1例为外踝Maisonneuve骨折合并下胫腓联合和内侧三角韧带损伤）.所有涉及外踝的骨折患者只有AO分型A型骨折采用2枚2.7 mm可吸收螺钉或1枚2.7mm可吸收螺钉辅助1枚1.5 mm可吸收棒固定,其余均采用接骨板螺钉固定.内踝骨折采用2～3枚3.5mm或4.0mm可吸收螺钉固定.1例下胫腓联合损伤采用2枚4.5 mm可吸收螺钉贯穿下胫腓固定.后踝骨折采用l～2枚4.0mm或4.5 mm可吸收螺钉从前向后固定.结果 16例患者术后获1.5～4.0年（平均28个月）随访.骨折愈合时间平均为3.0个月,无骨折延迟愈合及骨折不愈合,未出现伤口并发症.按美国足踝外科协会踝与后足功能标准评分评定疗效：优14例,良2例. 结论 可吸收螺钉内固定治疗踝关节骨折疗效好,无需行二次内固定取出手术,但要慎重选择骨折类型.

Objective To evaluate the efficacy and indications of bioabsorbable screws for the treatment of ankle fractures. Methods From June 2004 to December 2010,16 patients with ankle fractures [9 males and 7 female with a mean age of 35 years （ranging from 21 to 62 years） ] were treated with bioabsorbable screws.Among them,there were 4 cases of trimalleolar fracture （2 AO type B and 2 AO type C）,8 cases of bimalleolar fracture （all AO type B）,2 cases of medial malleolus fracture and 2 cases of lateral malleolus fracture（one AO type A and one Maisonneuve fracture complicated with separation of distal tibiofibular syndesmosis and deltoid ligament rupture）. Lateral malleolus fractures of only AO type A were fixated with one 2.7 mm bioabsorbable screw and one 1.5 mm bioabsorbable pin.Medial malleolus fractures were fixated with 2 bioabsorbable screws of 3.5 mm or 4.0 mm.In the one fracture combined with separation of the tibiofibular syndesmosis,2 bieabsotbable screws were implanted from the fibula to the tibia to fixate the syndesmosis.For posterior malleolus fractures,one or 2 bioabsorbable screws of 4.0 mm were implanted from forwards to backwards.Results Sixteen patients were followed up from 1.5 to 4.0 years,with an average of 28 months.All fractures healed after an average of 3 months.According to the AOFAS （American Orthopaedic Foot and Ankle Society） evaluation system,14 patients obtained excellent results and 2 good.There were no such complications as delayed union or nonunion or wound problems. Conclusions Bioabsorbable screws are effective in treatment of ankle fractures and can spare a secondary operation to remove the implants.It is important,however,to judge the right types of ankle fracture because they are not suitable for all ankle fractures.