踝关节旋后-外旋Ⅳ度损伤的外科治疗分析

Evaluation of Long-term Results after Surgical Treatment of Supination-external Rotation( SER)Type Ⅳ Ankle Injuries

目的总结踝关节旋后-外旋Ⅳ度损伤的外科治疗方法和临床疗效。方法选用2012年8月至2014年7月间手术治疗的65例Lauge-Hanse分型旋后-外旋Ⅳ度的踝关节损伤进行随访并评估分析。其中男28例,女37例;年龄18~71岁,平均47.4岁。骨折按Danis-Weber分型,A型18例,B型39例,C型8例。术后半年根据美国矫形足踝协会踝与后足评分标准进行功能和疗效评估。结果随访时间为7~30个月,平均16个月,骨折愈合时间12~16周,平均12.8周。本组评分78~100分,平均90.6分;优（90~100分）34例,良（80~89分）24例,一般（70~79分）7例,差（≤69分）0例,优良率为89.2%。结论踝关节旋后-外旋Ⅳ度损伤属于不稳定性踝关节骨折,当破损的骨折结构通过合理手术重建修复固定后,即可得到一个相对稳定的踝关节,一般无需三角韧带修补,很少需要下胫腓联合螺钉固定。

Objective To evaluate long-term results after surgical treatment of supination-external rotation（ SER） Type Ⅳankle injuries. Methods 65 patients with SER Type Ⅳ ankle injuries who underwent operative treatment between August2012 and July 2014 were included and followed-up. Among them,28 were male and 37 were female. Age ranged from 18 to 71 years,with an average age of 47. 4. According to Danis-Weber,there were 8 cases of type A,39 cases of B and 8 cases of type C. Foot function was assessed based on the American orthopaedic foot and ankle society（ AOFAS） ankle and foot scoring criteria. Results The mean follow-up time was 16 months with a range of 7 to 30 months. The recovery time of fracture varied from12 to 16 weeks,with an average of 12. 8 weeks. The average function and effectiveness score was 90. 6 with 34 graded as excellent（ 90 ~ 90）,24 good（ 80 ~ 89）,7mediocre（ 70 ~ 79）,and 0 poor. 89. 2% of patients achieved good functional recovery.Conclusion SER Type Ⅳ ankle injuries is unstable ankle fracture. With appropriate reconstructive surgery to repair and fix damaged structure,a relative stable ankle can be expected. Generally deltoid ligament repair is unnecessary and syndesmosis screws is very rare.