全踝关节镜技术治疗Tillaux-Chaput骨折的疗效分析

Efficacy of full ankle arthroscopy in treatment of Tillaux-Chaput fractures

目的探讨采用全踝关节镜技术治疗Tillaux-Chaput骨折的疗效。方法回顾性分析2013年5月-2015年5月采用全踝关节镜技术治疗并获得随访的21例Tillaux—Chaput骨折患者资料，其中男16例，女5例；年龄6～55岁[（25．5±12．8）岁]。右侧12例，左侧9例。单纯Tillaux—Chaput骨折16例，Tillaux—Chaput骨折合并腓骨近端骨折5例。经x线片确诊18例，经cT扫描确诊3例。采用全踝关节镜前外侧联合前内侧入路，复位骨折，并采用1-2枚Herbert双向加压螺钉固定。观察术后切口愈合情况、骨折愈合情况及视觉模拟评分（VAS）。根据美国足踝外科协会（AOFAS）踝与后足评分标准评价踝关节功能。结果21例切口均获得I期愈合，无神经、血管、肌腱损伤并发症。所有患者获得随访，时间12～25个月[（15．3±7．1）个月]。骨折均愈合，时间12～36周[（22．6±4．6）周]。术后VAS为（0．8±0．3）分，与术前（8．3±1．3）分比较差异有统计学意义（P〈0．05）。至末次随访时，患者均恢复正常踝关节功能，恢复正常行走步态，无踝关节痛及负重行走痛，AOFAS评分由术前（51．2±12．5）分提高到术后（92．7±16．5）分（P〈0．05），其中优19例，良2例，优良率为100％。结论采用前内侧联合前外侧入路全踝关节镜技术治疗Tillaux-Chaput骨折能够达到关节面的精准复位，疗效确切，值得临床推广应用。

Objective To investigate the clinical result of treating Tillaux-Chaput fractures using the full ankle arthroscopy technique. Methods A retrospective analysis was made on 21 patients with Tillaux-Chaput fractures followed up after treatment by the full ankle arthroscopy technique from May 2013 to May 2015. There were 16 males and 5 females, with the age range of 6-55 years [ （25.5 ±12.8）years]. Right ankle was involved in 12 patients and left ankle in 4 patients. Sixteen patients had single Tillaux- Chaput fractures and 5 patients had combined proximal fibular fractures. Diagnosis of Tillaux-Chaput fractures was confirmed by X-rays in 18 patients an CT in 3 patients. Ankle arthroscopy was used through the anterolateral and anteriormedal approaches for closed reduction and internal fixation using one or two Herbert screws. Wound healing, bone union and visual analogue score （VAS） were detected postoperatively. Function assessment was performed using the American Orthopedic Foot and Ankle Society （AOFAS） ankle-hindfoot scoring system. Results All incisions healed by first intention, without evidence of nerve, vessel and tendon injuries. Period of follow-up was （ 15.3 ±7. 1 ） months （range, 12-25 months）. Fracture healed within 12 to 36 weeks [ （22. 6 ± 4. 6）weeks ] after operation. VAS was （ 0. 8 ± 0. 3 ） points after operation, obviously lower than preoperative （ 8.3 ± 1.3 ） points （ P 〈 0. 05 ）. At the final follow-up, all patients regained normal ankle function and normal walking gait,without the presence of ankle pain and weight-bearing walking pain. AOFAS score was improved from preoperative （51.2 ＋ 12. 5 ） points to postoperative （92.7 ~ 16.5 ） points （P 〈 0.05 ）. Based on the AOFAS score, the results were excellent in 19 patients and good in 2 patients, with the excellent-good rate of 100%. Conclusion Full ankle arthroscopy by the anterolateral and anteriormedal approaches provides a precise and effective method for closed reduction and internal fixation of Tillaux-Chaput fractures and deserves clinical application.