“Logsplitter”损伤的治疗方法与预后评价

＂Logsplitter＂ injury in clinical treatment and prognosis evaluation in ankle fractures

目的通过回顾性分析“Logsplitter”损伤的病历资料，探讨其损伤机制、治疗方法及预后评价。方法回顾性分析2006年12月至2014年12月收治的共23例“Logsplitter”损伤患者病历资料，男17例，女6例；年龄21-60岁，平均（43．68±12．67）岁。致伤原因：摔伤9例，运动伤1例，坠落伤2例，交通伤10例，重物砸伤者1例。开放性损伤10例，其中Anderson—GustiloⅡ型7例，ⅢA型及以上3例；闭合性损伤13例。根据AO／OTA骨折分型，44C型19例，44B型3例，44A型1例。合并腓骨骨折22例，合并内踝骨折19例。观察结果，并评估疗效。结果23例均获得随访，随访时间0．4-2．37年，平均（0．91±0．26）年。21例行切开复位内固定术，2例行闭合复位外固定术及内踝骨折克氏针内固定术。17例行下胫腓联合螺钉固定，其中使用1枚螺钉固定14例，使用2枚螺钉固定3例；3．5mm螺钉使用率达到94．1％（16／17），均经三层皮质打人；合并内踝骨折均行复位空心钉／克氏针内固定术。其中使用2枚空心钉固定17例，使用克氏针固定2例。三角韧带损伤共14例（14／23，60．1％），其中3例为三角韧带完全断裂，2例行韧带修复术，1例行i角韧带（带线锚钉）重建术。术后踝关节周同皮肤平均愈合时间（2．26±1．91）周；骨折平均愈合时间（15．34±5．13）周；负重后关节疼痛合并关节间隙变窄者18例（18／23，78．3％）；术后感染2例（2／23，8．7％）；骨折延迟愈合1例。术后踝关节功能：背伸20°-31°，平均23．9°±2．21°；跖屈25°-34°，平均32．1°±4．13°，内翻18°-30°，平均23．91°±2．24°，外翻19°-30°，平均27．6°±3．81°。The American Orthopaedic：Foot＆AnkleSot·iety（AOFAS）踝-后足评分〉75分21例，优良率为91．3％。结论“Logsplitter”损伤是一种重要且独特的多方暴力所致的踝关节骨折、脱位、下胫腓分离并具有潜在软组织损伤、同时可能合并下穹窿的损伤；根据受伤机制及复位前影像学确诊“Logsplitter”损伤后选择合适时机及时进行手术干预，临床治疗效果较理想，预后功能恢复情况相对满意。

Objective ＂Logsplitter＂ injury as a kind of unique ankle fracture with the inferior tibiofibular syndesmosis sep- aration eaused by varieties of violence does not catch the attention of domestic orthopedic surgeons enough in the past years. This passage is to discuss the damage mechanism, clinical treatment and prognosis evaluation of this kind of injury through the analysis of the case of ＂Logsplitter＂ injury. Methods Retrospective analysis 23 patients of ＂Logsplitter＂ injury ft＇om December 2006 to December 2014, male in 17 cases, female in 6 cases, average age （43.68_＋ 12.67） years （21-60 years）. Hurt injury in 9 cases, sports injury in 1 case, falling injury in 2 cases, traffic; injuries in 10 cases, crushing injury in 1 case. Open injures in 10 cases, of which the Gustilo U type in 7 cases, Gustilo ]ilIA type or above in 3 cases, closed injuries in 13 cases. According to the AO/OTA fracture classification, 44c type in 19 cases, 44b type in 3 cases, 44a type in 1 case. Fibula fractures in 22 cases, 19 cases of medial malleo- lus fracture. Results 23 patients received follow-up, with an average period was （0.91_＋0.26） years （0.4-2.37 years）. 21 cases un- derwent open reduction internal fixation （ORIF）, 2 cases underwent closed reduction external fixation and K-wire fixation. 17 cases were fixed with the syndesmosis screws, among them,1 screw was used to fix 14 cases, two screws were used to fix 3 cases;the utili- zation rate of 3.5 mm screws is higher, at 94.1%, and all screws were entered through 3 layers of cortical; Combined with medial malleolus fracture cases were fixed with cannulated screws/K-wire internal fixation. Average healing time of the skin surrounding the ankle skin was （2.26± 1.91） weeks; average healing time of fracture was （15.34±5.13） weeks; Joint pain oeurred combined with joint space narrowing after loading in 18 cases, at 78.3%; Postoperative infection, 2 cases, the proportion was 8.7%; Fracture de-layed union 1 case. Functional examination of the ankle joint （angle measurement method）： I）orsiflexiun tverage angle （23.9±2.21） degrees, Plantar flexion average angle （32.1±4.13） degrees. Average angle of introversim3 was （23.91±2.24） degrees. Hallux valgus average angle （27.6±3.81） degrees. 75 points and over were got in AOFAS in 21 eases, the ratio of excellent was 91.3%. Conclu- sion ＂Logsplitter＂ injury represents a kind of important and unique ankle fracture, dislneation and the inferior tibiofibular syndes- mosis separation caused by varieties of violence, accompany with potentially soft tissue injury and ＂platford＂ injury, according to existing treatment principle and treatment strategy summarizied by us,the clinical therapeutie effect of this damage is ideal, functional recovery is relatively satisfactory prognosis.