漂浮体位双切口手术治疗旋后-外旋Ⅲ度/Ⅳ度踝关节骨折的临床应用

The clinical application of double incision under floating position in the surgery of ankle fractures typed SER Ⅲ/Ⅳ

目的评价漂浮体位双切口手术治疗Lauge-Hansen分型为旋后-外旋Ⅲ度/Ⅳ度踝关节骨折的临床应用疗效。方法回顾分析47例随访完整,符合后踝均需手术治疗、Lauge-Hansen分型为旋后-外旋Ⅲ度/Ⅳ度踝关节骨折并行切开复位内固定术治疗的病历资料。男31例,女16例;年龄19～54岁,平均31. 5岁;扭伤28例,车祸14例,摔倒5例; Lauge-Hansen分型为旋后-外旋Ⅲ度的19例,旋后-外旋Ⅳ度28例;采用漂浮体位双切口手术治疗29例(A组),采用仰卧位三切口手术治疗18例(B组)。比较漂浮体位双切口(A组)和传统仰卧位三切口(B组)手术时间、骨折愈合时间、踝关节功能以及并发症。结果 A组患者手术时间85～180 min,平均(103. 5±10. 2) min;骨折愈合时间9～56 w,平均(14. 8±1. 3) w;踝关节功能按照美国矫形足踝协会(AOFAS)评分,评分为49～100分,平均(86. 6±7. 3)分;获优17例,良8例,中3例,差1例,优良率为86. 2%;踝外侧切口接骨板外露1例,第一足趾半屈曲态1例,腓浅神经损伤1例,不良反应发生率为10. 3%。B组患者手术时间74～185 min,平均(100. 5±9. 9) min;骨折愈合时间9～55 w,平均(13. 9±1. 2) w;踝关节功能AOFAS评分为44～100分,平均(79. 9±6. 8)分;获优9例,良5例,中3例,差1例,优良率为77. 8%;螺钉误置入下胫腓韧带1例,从前向后的拉力螺钉未有效固定后踝骨折块1例,不良反应发生率为11. 1%。结论漂浮体位双切口治疗旋后-外旋Ⅲ度/Ⅳ度踝关节骨折可获得良好的临床疗效,但应根据后踝骨折块的大小等选择手术方案及内固定方式。

Objective To evaluate the clinical effect of floating-position double incision surgery on Lauge-Hansen fracture with posterior-lateral Ⅲ/Ⅳ. Methods 47 cases were followed up completely. The cases were typed posterior-lateral Ⅲ/Ⅳ by Lauge-Hansen and accepted double incision reduction and internal fixation. The cases included 31 men and 16 women whose age were 19 ~ 54( the average was 31. 5 years). There were 28 sprain cases,14 accident cases and 5 fall cases. 19 cases were typed post-rotation-external rotation Ⅲ by Lauge-Hansen,and 28 cases were typed rotation-external rotation Ⅳ,29 cases were treated with double incision under floating body position( group A) and 18 cases were treated with supine position using three incision( group B). The time of operation,fracture healing time,ankle function and complications of floating double incision( group A) and traditional three incision( group B) were compared. Results The operating time of group A was 85 ~ 180 min( the average was 103. 5 ± 10. 2 min). The fracture healing time was 9 W-56 W( the average was 14. 8 ± 1. 3 W). According to the American Orthopaedic Foot Association( AOFAS),the ankle function score of this group was 49-100 points( 86. 6 ± 7. 3 points). There were 17 excellent cases,8 good cases,3 poor cases,and the excellent rate was86. 2%. One case was exposed from ankle lateral incision grafts,one case with first toe semi-curvature,and one case with superficial nerve injury. The incidence of adverse reactions was 10. 3%. The operation time of group B was 74 min ~ 185 min( 100. 5 ± 9. 9 min). The fracture healing time was 9 W-55W( 13. 9 ± 1. 2). AOFAS score for ankle function was 44-100 points( 79. 9 ± 6. 8 points). The excellent rate was 77. 8%. There was one case that the screw was inserted into the lower tibia and fibular ligament,and another case that the anterior and backward tension screws were not effectively fixed. The incidence of adverse reactions was 11. 1%. Conclusion Floating double incision can obtain good clinical effect in the treatment of posterior-lateral-Ⅲ/Ⅳ,but the surgical plan and internal fixation method are chosen due to the size of posterior ankle fracture.