腓骨远端“Z”字延长治疗踝关节骨折后踝穴增宽

Z-OSTEOTOMY OF DISTAL FIBULA TO CORRECT WIDENED ANKLE MORTICE AFTER FRACTURE

目的探讨腓骨远端"Z"字延长治疗踝关节骨折后踝穴增宽的临床疗效。方法 2009年9月-2011年2月,采用腓骨远端"Z"字延长治疗5例踝关节骨折后踝穴增宽。男4例,女1例;年龄23～58岁,平均38岁。骨折内固定术后3个月开始功能锻炼后,逐渐出现踝穴增宽的相关症状,至此次入院时间为5～36个月,平均13.2个月。侧压试验阳性2例,阴性3例。根据美国矫形足踝协会(AOFAS)踝-后足功能评分为(50.2±17.3)分。结果术后切口均Ⅰ期愈合。5例均获随访,随访时间9～24个月,平均15.6个月。术后出现患肢轻中度肿胀,患侧足背前外侧皮肤麻木症状,均逐渐好转。X线片复查示腓骨均达骨性愈合,愈合时间为12～15周,平均13.5周。术后踝关节活动度较术前无明显改善。术后6个月AOFAS踝-后足功能评分为(76.8±11.2)分,末次随访时为(85.4±3.2)分,术后功能评分较术前显著提高,差异有统计学意义(P<0.05)。结论腓骨短缩是踝关节骨折后踝穴增宽主要原因;腓骨远端"Z"字延长可有效缩小踝穴宽度,增加踝关节稳定性,降低并发症发生率。

Objective To analyse the clinical outcomes of the Z-osteotomy of the distal fibula to correct widened mortice of the ankle after fracture. Methods Between September 2009 and February 2011, 5 patients （5 feet） with widened ankle mortice after fracture underwent Z-osteotomy. There were 4 males and 1 female, aged from 23 to 58 years （mean, 38 years）. At 3 months after operation of internal fixation when function exercises were done, patients got pains. The interval between trauma and operation ranged from 5 to 36 months （mean, 13.2 months）. Lateral pressure test showed positive in 2 cases and negative in 3 cases. American Orthopedic Foot and Ankle Society （AOFAS） ankle-hindfoot score was 50.2 ±17.3. Results Primary healing of incision was achieved in all cases. Five patients were followed up 9 to 24 months （mean, 15.6 months）. Mild to moderate swelling of the affected limb and anterolateral skin numbness of the i psilateral dorsal foot occurred, and gradually improved. The clinical exam and radiology showed bone union at 12-15 weeks （mean, 13.5 weeks）. Postoperative range of motion of ankle had no significant improvement. AOFAS anlde-hindfoot scores were 76.8 ±11.2 at 6 months after operation, and 85.4 ± 3.2 at last follow-up, showing significant differences when compared with preoperative score （P 〈 0.05）. Conclusion Shortened fibula is the main cause of widened ankle mortice after fracture; Z-osteotomy can effectively reduce the width of the ankle mortice, increase the stability of ankle joint, and decrease the complication rate.