踝关节开放性骨折合并脱位的急诊手术治疗

Open Fracture combined with Dislocation of Ankle joint Treated by Emergency Operation

目的探讨踝关节开放性骨折合并脱位的急诊手术方法和治疗效果。方法回顾分析急诊手术治疗踝关节开放性骨折合并脱位41例,男32例,女9例。伤口Gustilo分度,I度7例,II度31例,IIIA度3例。尽早给予有效抗生素及开始手术,冲洗及彻底清创后,根据骨折类型、脱位及伤口情况制定固定方法,I期完成骨折及关节复位、内固定。结果 41例患者均获随访,4例伤口发生浅表皮缘坏死,无1例发生伤口感染,踝部骨折12～20周愈合。用Mazur评分系统评估手术疗效:优33例、良8例。结论踝关节开放性骨折合并脱位患者应及早进行伤口彻底清创内固定手术治疗,保护好皮肤活力,骨折及关节解剖复位,坚强内固定,恢复踝关节生物力学环境,可获得满意治疗效果。

Objective To discuss the open ankle fractures with dislocation of the emergency operation method and therapeutic effect of. Methods Aretrospective analysis of emergency operation for the treatment of ankle fracture combined with dislocation in 41 cases, male 32 cases, female 9 cases. Wound Gustilo index, I 7 cases, II 31 cases, IIIA 3 cases. As soon as possible to give effective antibiotics and began operation, irrigation and debridement, according to the type of fracture, dislocation and the wound fixed method, I complete fractures and joint reduction, internal fixation. Results 41 patients were followed up, 4 cases wound superficial epidermal necrosis, no one case of wound infection, 12 to 20 weeks of healing of fractures of the ankle. With Mazur scoring system to evaluate the operation efficacy： excellent in 33 cases, good in 8 cases. Conclusion Open ankle fractures with dislocation of patients should be performed early wound debridement and internal fixation operation treatment, protect skin vitality, fractures and joint anatomic reduction, rigid internal fixation, rehabilitation of ankle biomechanics environment, can obtain a satisfactory therapeutic effect.