踝关节骨折手术治疗的观察

Observation on surgical treatment of ankle fractures

目的观察踝关节骨折的手术治疗效果。方法通过手术治疗的76例踝关节骨折患者按Danis-Weber分类A型3例,B型40例,C型33例。内固定治疗方法:内踝骨折行松质骨螺钉或克氏针钢丝张力带内固定,外踝骨折行切开复位钢板螺钉固定,后踝骨折移位超过关节面1/4者行复位,从前向后或从后向前拧入半螺纹拉力螺钉固定。术后均采用石膏绷带或支具外固定,6～8周摄X线片显示有骨痂形成时下地负重。结果全部患者均得到随访,随访时间9个月~5年,平均2.1年。68例(89.5%)X线片显示:骨折愈合,无移位,踝关节位置及间隙正常。8例(10.5%)可见踝关节周围骨不同程度的骨质疏松。踝关节主动活动71例(93.4%)达到正常范围。4例有轻度背伸受限(均为术后9个月内)。按AOFAS功能评分:优62例,良11例,可2例,差1例,优良率96.0%。结论对于移位需手术的踝关节骨折行切开复位内固定和早期功能锻炼,能取得良好的治疗效果。

Objective To observe the effects of surgical treatment of ankle fractures. Methods 76 operated cases of ankle fractures were classified into the type A in 3 cases, the type B in 40 cases and the type C in 33 cases according to the Danis- Weber classification. The internal fixation methods included cancellous screws or Kirxchner steel-wire tension fixation for medial malleolus fractures,open reduction and steel screws fixation for lateral malieolus fracture and reduction for posterior malleolus fracture in which displacement surpassing more than 1/4 al^icular surface and half-thread tension screws fixation from front to back or back to front. After operation,the external fixation with plaster bandage or orthoses was adopted. After callus formation showed by 6-8 weeks X-ray, walk and loading began. Results All cases were followed up for 9 months to 5 years （average 2.1 years）. X-ray showed fracture healing without shift and with normal ankle position and joint space in 68 cases （89.5%） and dif- ferent degrees of osteoporosis of periankle bones in 8 cases （10.5%）. The ankle active activities were reached to the normal range in 71 cases （93.4%）. 4 cases had mild back stretch restricted （both whithin postoperative 9 months）. According to AOFAS func- tional scoring, 62 cases were optimal, 11 cases were good, 2 cases were fair and 1 case was poor, with the excellent rate of 96.0%. Conclusion Open reduction,internal fixation and early functional excercises in ankle fractures in which shift needs surgery can obtain good curative effects.