切开复位内固定治疗旋后外旋型踝关节骨折的临床疗效

Treatment of supination External Rotation Ankle Fractures through open reduction of internal fixation(ORIF)

目的探讨切开复位内固定定治疗Lauge-Hansen旋后外旋型Ⅲ-Ⅳ度踝关节损伤的临床疗效。方法男19例,女11例,平均年龄42岁,均为Lauge-Hansen旋后外旋型踝关节损伤,其中Ⅲ度9例,Ⅳ度21例。合并下胫腓分离2例,内踝无骨折而三角韧带损伤4例,所有患者均存在后踝骨折。Ⅲ度患者采用单一后外侧切口,Ⅳ度增加内踝切口,手术顺序依次为后踝、外踝、内踝。30例均获得10-16个月的随访(平均11个月)。结果后踝骨折T型钢板固定8例,螺钉固定22例。4例三角韧带损伤患者,1例在后踝、外踝复位固定后,踝关节内侧间隙仍增宽,作内踝切口探查,发现三角韧带断裂、并嵌于关节间隙,予以抽出并修复;另3例后踝及外踝固定后,踝关节内侧间隙恢复正常,未作内侧切口探查。2例下胫腓分离患者,1例通过下胫腓螺钉固定;另1例在后踝及外踝固定后,行腓骨牵拉试验检查为阴性,故未行下胫腓螺钉固定。根据Baird-Jackson评分,本组优23例,良5例,可2例,优良率为93.3%。结论后外侧切口尤其适用于Lauge-Hansen旋后外旋型Ⅲ度踝关节损伤,仅用一个切口即可完成后踝及外踝骨折的治疗,后外侧软组织厚实,对内置物覆盖好,其反过来也减少了内置物的激惹及伤口并发症;后踝可在直视下准确复位、固定可靠,患者术后可早期功能锻炼、功能恢复快。

Objective To study clinical effect of supination external rotaion ankle fractures three stages and four stages. Mthods A retrospective study was done for 30 patients with supination rotation fracture of ankle who were treated from April 2013 to October 2014 in our department,9 patients belonged to stage Ⅲ,21 to stage Ⅳ. All of them exited posterior malleolus fracture,we prefer set the posterior malleolus before the fibula,then medial malleolus. 30 patietns completed the follows-ups which ranged from 10 to 16 months（average,11months）. 2 cases with the diastais of the inferior tibiofibular ligament,4 cases with the deltoid ligament rupure. A single posterolateral approach for the patients of stage Ⅲ,an additional medial approach for stage Ⅳ. Results The fixation type of posterior malleolus into T shaped plate and screw,8 cases by T shaped plate and 22 cases by screws. When the posterior malleolus and fibula fixed well,3 cases with the deltoid ligament rupure,medial space recover nomally;The fourth became normal through an additional medial incision for repaired the deltoid ligament. One of 2 cases with the diastais of the inferior tibiofibular ligament,which was normal after the fixation of posterior malleous and fibual,the other was fixed by inferior tibiofibular screw. According to Baird-Jackson scores,excellent 23,good 5,pair 2,with an excellent to good rate 93.3%. Conclusion The posterolateral approach is especially good for the stage 3 of supination External Rotation Ankle Fractures,because only one incision can fixed well posterior malleous and fibula. The approach utilizes an internervous plane which provides a large soft tissue envelope for postoperative coverage,which in turn theoretically decreases the risk of painful hardware of wound complications. The posterior malleous fragments can be reduced anatomicly by the approach,the screw is inserted in a posterior to anterior direction,this rigid fixation fasctitated to move the ankle joint early.