移位性踝关节骨折延迟性手术的术式选择

The selection of procedures of delayed surgery for displaced ankle fractures

目的探讨移位性踝关节骨折延迟性手术的术式选择及疗效。方法对23例移位性踝关节骨折患者施行延迟性手术，16例行切开复位内固定术，7例行踝关节融合术，并应用AOFAS评分系统进行评价。结果随访25－173个月，平均80个月。骨折全部愈合，均获得无痛性可负重关节。延迟1－3个月者，切开复位内固定组的术后AOFAS评分有较大的提高。延迟3个月以上者，两种术式AOFAS评分提高的幅度相差不大。结论延迟1～3个月的骨折，如踝穴恢复完整并获得解剖复位，应选择切开复位内固定术，否则，可采用关节融合术。延迟3个月以上的骨折由于软骨和软组织的退变，获得解剖复位的难度增大，宜采用关节融合术。

Objective To select the operative procedures and confirm their efficacies on delayed ankle fractures with displacement. Methods 23 patients with displaced ankle fractures treated with delayed surgery were reviewed. 16 patients underwent open reduction and internal fixation, 7 underwent arthrodesis.All of the patients were evaluated by AOFAS rating system. Results All of the 23 patients were followed up from 25 months to 173 months, with an average of 80 months. All of the fractures healed up and the patients have had painless joints. Compared with the arthrodesis, the patients received open reduction and internal fixation within 1 - 3 months had higher AOFAS scores. However, there was no significant difference between the final results following these two operative procedures in AOFAS score if the surgery was delayed over 3 months. Conclusion In the case of fracture of the ankle with delayed treatment of 3 months, anatomical reduction can be attained by open reduction and internal fixation. Otherwise, arthrodesis should be considered. Anatomical reduction is difficult due to the degenerative changes of the cartilage and the soft tissue, sofor the delayed treatment of displaced ankle fracture, arthrodesis is the best choice.