延期手术治疗Maisonneuve骨折

Maisonneuve fractures treated with delayed surgery

目的探讨延期手术治疗Maisonneuve骨折的临床疗效。方法对2006年1月至2011年6月延期手术治疗的21例Maisonneuve骨折患者的病例资料进行回顾性分析，男18例，女3例；年龄17～63岁，平均36．8岁。所有患者均存在下胫腓韧带损伤，合并外踝骨折17例，内踝骨折14例，三角韧带断裂7例，后踝骨折15例。所有患者均由于复合伤、皮肤条件差、漏诊等原因未得到及时手术，其中2周后手术者6例，3周后手术耆11例，4周后手术者4例。受伤至手术时间为14～32d，平均为21．3d。手术切开复位内固定外踝、内踩、后踝骨折，修复重建断裂的三角韧带和下胫腓前韧带，术后采用美国足踝外科协会（AOFAS）踝．后足评分对踝关节功能进行评价。结果所有患者术后获10～18个月（平均12．3个月）随访，骨折均获愈合，愈合时间为10～22周，平均12．4周。所有患者无发生感染、内固定松动和断裂。踝关节屈曲活动于术后6个月左右基本恢复至对侧水平，但内外翻幅度受限、疼痛广泛存在，末次随访时仍有10例（47．6％）患者与对侧差别明显。5例患者出现距骨外移，不同程度的踝穴增宽。疗效按照AOFAS踝一后足评分进行评价：优5例，良9例，可4例，蔗3例，优良率为66．7％。结论MaisonneHve骨折延期治疗手术难度大，术后踝关节功能恢复困难。甲．期诊断和早期手术是治疗的关键。

Objective To study the clinical effects of delayed surgery for Maisonneuve fractures. Methods Between January 2006 to June 2011, we treated 21 patients with Maisonneuve fracture by delayed surgery. They were 18 men anti 3 women, aged from 17 to 63 years （average, 36. 8 years）. Rupture of inferior tibiofibular ligaments was complicated in all, lateral malleolus fracture in 17 cases, medial malleolus fracture in 14 cases, rupture of dehoid ligament in 7 cases, and posterior malleolus fracture in 15 cases. None of them got timely surgery due to complicated injuries, poor skin condition or missed diagnosis. Six patients had surgery after 2 weeks, 11 after 3 weeks and 4 after 4 weeks. The interval from injony to surgery ranged from 14 to 32 days, averaging 21.3 days. Fractures of lateral, medial and posterior malleolus were treated with open reduction and internal fixation. Ruptures of deltoid ligament and anterior ligament of inferior tibiofibula were repaired and reconstructed. Functional recovery of the ankle joint was assessed using Ameriea,1 Orthopaedic Foot and Ankle Society （AOFAS） scoring system. Results The patients were followed up fn 10 to 18 months （average, 12. 3 months）. All the fractures healed after an average time of 12.4 weeks （from 10 to 22 weeks） . No infection or implant failure was observed in this group. The affected ankle restored inflexion basically to the range of the eontralatera] 6 months post-surgery, but was limited in the ranges of varus and valgus. Pain was extensively experienced. At the last follow-up, 10 patients （47.6%） showed obvious disparity hetween the 2 sides, and 5 ones had lateral displacement of the talus and widened ankle mortise. AOFAS results were excellent in 5 cases, good in 9, tair in 4 and poor in 3, yielding a good to excellent rate of 66.7%. Conclusion Because delayed surgery increases the difficulties in surgery and functional reovery, early diagnosis and early surgery are crucial for treatment of Maisonneuve fractures to achieve satisfactory outcomes.