手术治疗Maisonneuve骨折的疗效观察

ANALYSIS OF CLINICAL EFFECT IN SURGICAL TREATMENT OF Maisonneuve FRACTURE

目的探讨手术治疗Maisonneuve骨折的方法及近期疗效。方法 2010年1月-2013年2月,收治23例Maisonneuve骨折患者。男14例,女9例;年龄30-68岁,平均40.3岁。致伤原因：摔伤11例,运动伤5例,交通事故伤4例,高处坠落伤3例。受伤至手术时间7-10 d,平均8.5 d。均为闭合性损伤。其中3例伴三角韧带损伤。手术复位固定内踝及后髁骨折,锚钉缝合修复三角韧带,探查修复或复位固定下胫腓联合。结果术后患者切口均Ⅰ期愈合,无手术相关并发症发生。21例患者获随访,随访时间24-36个月,平均26.5个月。患者踝关节均无疼痛、压痛及明显肿胀。X线片复查示,术后3-6个月（平均4.6个月）腓骨及踝部骨折均骨性愈合,踝穴正常,腓骨长度恢复,内固定牢固,无创伤性关节炎发生。术后1年,踝关节背伸、跖屈活动度均达30-40°,平均34.5°。末次随访时,根据Baird-Jackson踝关节功能评价标准评分为85-100分,平均94分;其中优16例、良4例、可1例,优良率为95.2%。结论根据Maisonneuve骨折受伤机制,通过固定内踝、后踝,修复三角韧带,固定下胫腓联合,可获得良好疗效。

Objective To investigate the operative method and short-term effectiveness in the surgical treatment of Maisonneuve fracture. Methods Between January 2010 and February 2013, 23 patients with Maisonneuve fracture were treated. There were 14 males and 9 females with an average age of 40.3 years （range, 30-68 years）. The causes of injuries were falling injury in 11 patients, sports related injury in 5 patients, traffic accident injury in 4 patients, and falling injury from height in 3 patients. The interval between injury and operation was 7-10 days （mean, 8.5 days）. All of fractures were closed. Three patients had combined injury of deltoid ligament. The surgical procedures included surgical reduction and fixation of medial malleolus fracture and posterior malleolus fracture, repair of the deltoid ligament with ground anchor suture, and fixation of the disrupted distal tibiofibular syndesmosis. Results All incisions achieved primary healing, no postoperative complications such as infection occurred. Twenty-one patients were followed up 24-36 months （mean, 26.5 months）. No patients complained of pain, tenderness, and obvious swelling of the ankle. At 3-6 months （mean, 4.6 months） after operation, X-ray films showed bony union of fractures and normal mortises in 21 patients. And no traumatic arthritis was observed with reliable fixation. The range of motion of ankle dorsi flexion and plantar flexion was 30-40° （mean, 34.5°）. Baird-Jackson ankle functional score was 85-100 （mean, 94）; 16 cases were rated as excellent, 4 as good, and 1 as fair with an excellent and good rate of 95.2%. Conclusion Surgical treatments of Maisonneuve fracture include surgical reduction and fixation of the medial malleolus and posterior malleolus, repair of the deltoid ligament and fixation of the disrupted distal tibiofibular syndesmosis, and good effectiveness can be achieved.