三踝骨折伴踝关节半脱位的治疗

Treatment of trimalleolar fractures with subluxation of the ankle

目的 :探讨三踝骨折手术入路、顺序及方法 ,提高临床疗效。 方法 :①通过对 7例新鲜踝关节标本的测量 ,了解三踝骨折的最佳手术入路 ;②根据解剖测量及踝关节损伤生物力学机制分析结果 ,对 16例三踝骨折伴踝关节半脱位的患者进行治疗。 结果 :①通过后内侧切口暴露后踝 ,视野宽及深度较浅 ,视角大 ,易于暴露。与后外侧切口相比有明显的优势。②手术顺序为外踝→后踝→内踝 ,术中强调外踝的解剖复位 ,经前内侧入路固定后踝 ,易于操作 ,固定可靠 ,取出方便。③本组 16例患者中 15例疗效评定为优良 ,优良率达 93.7%。 结论 :先采用外侧切口复位固定外踝 ,然后行后内侧“L”形切口复位固定后踝及内踝是三踝骨折较理想的手术入路及顺序 ,其中外踝解剖复位、固定可靠是恢复踝关节正常榫状结构的关键 ,可以获得良好的临床效果。

Objectives: To improve the clinical curative effect of trimalleolar fractures by exploring the rational operative approach, order and methods of trimalleolar fractures with subluxation of the ankle. Methods: ① Seven fresh ankles were measured to elucidate the most rational operative approach of the trimalleolar fractures. ②Based on the results of the measurement and the analysis of biomechanical mechanism of the ankle injury, 16 patients with trimalleolar fractures and subluxation of the ankle joint were treated. Results:① The data of the ankle measurement showed that the posterio medial incision of the ankle had a wide and shallow field of vision and big angle of view compared with the posterio lateral incision, thus the posterio medial incision had a significant advantage in exposing the posterior malleolus. ② The rational operative order was lateral, posterior and medial malleolus. It should be emphasized that reduction of the lateral malleolus should be anatomical, and fixation is rigid. By anterio internal approach, it was easy to fix the posterior malleolus and to remove the implant. ③ The above operative approaches and methods were applied to 16 patients, and 15(93.7%) had excellent or good result. Conclusions: The rational operative approaches and methods of the trimalleolar fractures were reducing and fixing the lateral malleolus by lateral incision, posterior and medial malleolei by posterio medial 'L' incision, and operative order was lateral, posterior and medial malleolus. The anatomical reduction and rigid fixation of the lateral malleolus play a key role in resuming the normal structure of ankle joint. Treatment of trimalleolar fractures using above operative approaches and methods may attain good clinical results.