累及Tillaux-Chaput骨块的成人踝关节骨折临床特点及手术疗效

CLINICAL FEATURES AND SURGICAL EFFECTIVENESS OF ANKLE FRACTURES INVOLVING Tillaux-Chaput IN ADULTS

目的探讨累及Tillaux-Chaput骨块的成人踝关节骨折的临床特点及手术疗效。方法回顾分析2009年5月-2013年5月,采用切开复位内固定术治疗的15例累及Tillaux-Chaput骨块的成人踝关节骨折患者临床资料。男12例,女3例;年龄19~45岁,平均32岁。致伤原因:运动损伤8例,交通事故伤5例,高处坠落伤2例。左侧5例,右侧10例;其中2例为开放骨折(GustiloⅠ型),13例闭合骨折;单独Tillaux-Chaput撕脱骨折5例。骨折根据Lauge-Hansen分型,旋后外旋型9例,旋前外旋型5例,旋前外展型1例。受伤至手术时间3 h^15 d,平均8.5 d。结果术后2例患者切口发生皮肤浅层感染,经口服抗生素及换药后愈合;其余患者切口均Ⅰ期愈合,无感染及神经血管损伤等并发症发生。患者均获随访,随访时间13~36个月,平均23个月。X线片复查示,所有骨折均达骨性愈合,愈合时间10~16周,平均13周。术后1年,根据美国矫形足踝协会(AOFAS)踝与后足评分标准评价踝关节功能为78~99分,平均87分;获优9例,良3例,可3例,优良率达80%。结论手术治疗累及Tillaux-Chaput骨块的成人踝关节骨折有利于患者踝关节功能恢复,可获得较好临床疗效。

Objective To investigate the clinical features of ankle fractures involving Tillaux-Chaput in adults, and to observe the surgical effectiveness. Methods Between May 2009 and May 2013, 15 adult patients with ankle fractures involving Tillaux-Chaput were treated by open reduction and internal fixation. There were 12 males and 3 females, with an average age of 32 years （range, 19-45 years）. The causes included sport injury （8 cases）, traffic accident injury （5 cases）, and falling injury from height （2 cases）. The left ankle was involved in 5 cases and the right side in 10 cases. There were 2 open fractures （Gustilo type I） and 13 close fractures. Five patients had single TiUaux-Chaput fractures. The mean time between injury and surgery was 8.5 days （range, 3 hours to 15 days）. According to the Lauge- Hansen classification, there were 9 cases of supination-external rotation, 5 cases of pronation-external rotation, and 1 case of pronation-abduction. Results Primary healing of incisions was obtained in 13 patients without infection and neurovascular injury, 2 patients had superficial infection which was cured after oral antibiotics and dressing change. All cases were followed up for 23 months on average （range, 13-36 months）. X-ray Films showed complete fracture healing at 10-16 weeks postoperatively （mean, 13 weeks） in all cases. The mean American Orthopaedic Foot and Ankle Society （AOFAS） score was 87 （range, 78-99）, with an excellent and good rate of 80% （excellent in 9 cases, good in 3 cases, and fair in 3 cases）. Conclusion Open reduction and internal fucation for ankle fractures involving Tillaux-Chaput in adults can achieve excellent effectiveness.