踝关节骨折手术治疗的预后分析

Prognostic analysis of ankle fractures for surgery

目的：探讨踝关节手术的方法及预后。方法选择2012年1月至2016年1月76例踝关节骨折患者，左、右踝分别为41、35例，单、双、三踝骨折分别24、27、25例。内踝骨折选用螺钉或张力带钢丝固定，腓骨下1/3斜形骨折、螺旋型骨折选用1/3管状钢板固定或加压钢板固定；并发后踝骨折时，如后踝骨折块累及胫距关节面25％以上，选用螺钉内固定；下胫腓关节分离不稳，需行下胫腓骨联合螺钉内固定。运用 AOFAS 评分系统对76例踝关节骨折术后疗效进行判定。术后健、患侧活动度比较采用配对 t 检验。结果内翻角度和后足运动度比较差异未见统计学意义，而患侧与健侧矢状面运动度、背伸度、跖屈度和外翻度比较差异有统计学意义（P ＜0.05）。经22个月随访，根据美国足踝协会踝与后足功能评分结果，优62例，良14例，优良率为100％。结论尽早行手术复位内固定结合早期运动锻炼，对治疗踝关节骨折是一种很有效的方法，值得在临床工作中推行。

Objective To investigate the clinical effect and prognostic factors of ankle fractures. Methods From January 2012 to January 2016,76 patients with ankle fractures were selected. Thirty-five cases had injury on the right ankle,and 41 on the left. There were 24 cases of single ankle fracture, 27 cases of bimalleolar fractures and 25 cases of trimalleolar fractures. Screws were used for simple medi-al malleolus fracture. Tension band were used for comminuted medial malleolus fracture. Posterior malle-olus fracture involving the joint surface of tibia and talus need internal fixation,if it was more than 25% . The outcomes were assessed by American Orthopaedic Foot and Ankle Society（AOFAS）scoring scale. The activity of the healthy ankle and the injured side were compared by paired t-test. Results There was no significant difference in the degree of inversion angle or posterior foot movement,but there was significant difference in the degree of motion,back extension,plantar flexion degree and valgus angle be-tween the affected side and the contralateral side. The length of follow-up ranged 4 to 32 months. Ac-cording to AOFAS scoring scale,62 patients had excellent outcomes and 14 patients felt good. The excel-lent and good rate was 100% . Conclusions Early open reduction and internal fixation combined with early exercises is an effective method for ankle fracture,and it is deserved to promote in clinical work.