双钢板治疗合并胫骨远端关节面压缩的旋后内收型Ⅱ度踝关节骨折

Treatment of grade Ⅱ supination adduction ankle fractures with impaction of tibial plafond using double-plate fixation

目的探讨双钢板治疗合并胫骨远端关节面压缩的旋后内收型Ⅱ度踝关节骨折的疗效。方法选择17例合并胫骨远端关节面压缩的旋后内收型Ⅱ度踝关节骨折患者,踝关节前内侧入路直视下复位内踝及胫骨远端塌陷关节面,植骨支撑,于胫骨远端前内侧行桡骨远端钢板支撑固定,在软骨下骨区打入3枚螺钉,对塌陷的关节面实现直接坚强固定,内踝行防滑钢板固定。腓骨骨折予重建钢板固定。术后定期复查X线片观察骨折愈合情况,采用美国足踝外科医师协会(AOFAS)踝-后足评分系统对踝关节功能进行评估。结果横断位CT研究发现12例(70.6%)塌陷关节面主要位于胫骨远端前内侧1/4关节面区,以前缘最严重。5例(29.4%)塌陷区仅位于胫骨前内缘,关节面中部无累及。17例中16例获得随访,平均(2.6±0.9)年,骨折平均(2.9±0.5)个月愈合。X线片未出现内固定松动断裂,胫骨远端关节面复位无丢失。踝关节活动度背伸平均16.4°±2.8°,跖屈平均39.2°±5.3°。按AOFAS踝-后足评分系统,优14例,良2例,优良率100%。结论双钢板治疗合并胫骨远端关节面压缩的旋后内收型Ⅱ度踝关节骨折可以对胫骨远端关节面充分支撑固定,减少复位丢失,降低创伤性关节炎的发生率。

Objective To evaluate the effect of double-plate treatment on grade Ⅱsupination adduction ankle frac tures with impaction of tibial plafond. Methods A total of 17 patients of gradeⅡsupination adduction ankle fractures with impaction of tibial plafond were treated surgically in our hospital. Anteromedial approach to the medial malleolus was taken to expose the tibial plafond and the vertical medial malleolus fractures. One distal radius plate was placed on the anteromeidal tibial plafond, and another buttress plate was placed on the medial malleolus. Bone grafting was used to restore the height of the collapsed tibia. Lateral malleolus fractures were treated with reconstruction plate. The fracture union after operation was detected by X-ray examination. American Orthopedic Foot and Ankle Society （AOFAS） ankle hind foot score was used to assess the ankle function. Results Sixteen of 17 patients were followed up postoperatively for a mean period of 2.6 ± 0.9 years. CT cross-sectional study found that the collapsed articular surface of 12 （70.6%） patients was mainly located in the anteromedial one-fourth area, with the worst at anterior margin. Bony fusion was achieved in all patients after an average period of 2.9±0.5 months. No internal fixation loosening or fracture redisplacement was found by X-ray. The average range of ankle joint activity was 16.4°±2.8° for dorsiflexion, and was 39.2°±5.3° for plantarflexion. According to AOFAS ankle hindfoot scale, ankle function was excellent in 14 patients and good in 2, with excellence rate of 100%. Conclusion The application of double-plate fixation to treat gradeⅡsupination adduction ankle fractures with impaction of tibial plafond can play a key role in reducing fracture redisplacement and osteoarthritis.