微创经皮内固定治疗复杂踝部骨折53例

Minimally invasive percutaneous osteosynthesis for the treatment of 53 patients with complex ankle fractures

目的:探讨微创内固定治疗复杂踝部骨折的手术方法和临床疗效。方法 :自2007年1月至2011年12月,采用微创经皮内固定治疗53例复杂踝部骨折患者,男31例,女22例;年龄18~65岁,平均38.2岁。按LaugeHansen分型:旋后外旋型Ⅳ度32例,旋前外旋型Ⅲ、Ⅳ度13例,旋前外展型Ⅲ度5例,因腓骨骨折严重粉碎无法分类3例。Denis-Weber分类:A型4例,B型34例,C型15例。受伤至手术时间2 h^14 d,平均5 d。骨折复位固定顺序为后踝、内踝、外踝和下胫腓联合。后踝骨折采用踝前切口间接复位固定,内外踝骨折采用经皮螺钉、接骨板或张力带固定,必要时螺钉固定下胫腓联合。术后采用Baird-Jackson评价系统进行疗效评价。结果:48例获随访,时间10~36个月,平均13个月。骨折全部愈合,愈合时间10~18周,平均12周。根据Baird-Jackson评价系统进行疗效评定,术后踝关节功能平均(94.7±4.2)分,其中优28例,良15例,可3例,差2例。1例发生皮肤浅表性感染,经换药治愈;2例发生下胫腓联合固定螺钉断裂。结论:采用微创经皮内固定治疗复杂踝部骨折可保证踝关节获得解剖复位,保护骨折端血运及软组织覆盖,最大限度地恢复踝关节功能,获得满意的临床疗效。

Objective：To explore the surgical method and its clinical effects of minimally invasive osteosynthesis on the treatment of complex ankle fractures. Methods：From January 2007 to December 2011,53 patients with complex ankle frac- tures were treated with minimally invasive osteosynthesis. There were 31 males and 22 females,with an average age of 38.2 years old （ranged, 18 to 65）. According to the system of Lauge-Hansen, 32 fractures were supination external rotation injury （grade Ⅳ ）, 13 fractures were pronation external rotation （ grade Ⅲ or Ⅳ ） ,5 fractures were prouation abduction （ grade Ⅲ） ; and 3 fractures can not be classified due to serious comminution fracture of fibula. According to the system of Denis-Weber, there were 4 cases with type A, 34 cases with type B and 15 cases with type C. Seven cases were open fractures. The duration from injuries to operation ranged from 2 hours to 14 days with an average of 5 days. The sequence of reduction and fixation of ankle fractures was firstly posterior malleolus, then medial malleolus and lateral malleolus, and inferior tibiofibular syndesmosis lastly. The fractures of posterior malleolus were reduced and fixed through anterior ankle approaches ; the fractures of medial and lateral malleolus were percutaneously fixed with bolts or blade plate or tensile force band;and inferior tibiofibular syn- desmosis were firmly fixed if necessary. Baird-Jackson scoring system was used to evaluate clinical effects. Results： Forty-eight patients were followed up from 10 to 36 months with an average of 13 months. The fractures got healing with an average time of 12 weeks （ranged, 10 to 18）. According to the Baird-Jackson scoring system,the mean score of ankle function was 94.7±4.2, and 28 cases obtained excellent results, 15 good, 3 fair and 2 poor. One case experienced superficial infections and was cured by changing dressings, 2 cases experienced fixed syndesmosis screw breakage. Conclusion： The surgical method of minimally invasive osteosynthesis can ensure the anatomical join restoration ,protect the blood supply of fracture end ,rebuild the function of ankle joint, obtain satisfactory clinical results in treating complex ankle fractures.