老年踝关节骨折治疗中腓骨远端内固定方法的个体化选择

Iindividual choice of distal fibula internal fixation for ankle fractures in elderly

目的：探讨老年踝关节骨折治疗中腓骨远端内固定方法的个体化选择及临床疗效。方法：回顾性分析2012年5月至2015年4月手术治疗的68例老年踝关节骨折病例,其中男37例,女31例;年龄62~81岁,平均69.2岁。根据Danis-Weber分型：Weber A型19例;Weber B型31例,Weber C型18例。Lauge-Hansen分型：旋后外旋型22例,旋前外旋型18例,旋后内收型19例,旋前外展型9例。所有患者根据骨折类型和个体化差异对腓骨远端骨折采用不同的内固定方法治疗。观察术后临床检查、影像学指标,并采用美国足踝外科学会（AOFAS）踝-后足功能评分进行手术疗效评价。结果：本组Herbert螺钉固定12例,克氏针张力带固定7例,1/3管型钢板固定5例,重建钢板固定6例,腓骨远端解剖复合钢板固定17例,腓骨远端解剖锁定钢板固定21例。术后所有患者均获随访,时间12~26个月,平均17.7个月。切口均Ⅰ期愈合。无感染及皮肤坏死,未出现骨不愈合、踝关节不稳、内固定松动断裂。骨折愈合时间为2.7~4.0个月,平均3.2个月。不同内固定组患者AOFAS评分、VAS评分、踝关节活动度比较,差异无统计学意义（P〉0.05）;骨折愈合时间比较,差异有统计学意义（P〈0.05）。踝关节活动度背伸为6°~18°,平均15°;跖屈26°~47°,平均37°。末次随访时AOFAS评分88.4±4.3,其中优34例,良30例,可4例。结论：在老年踝关节骨折的手术治疗中,采用个体化内固定腓骨远端骨折可以获得良好的临床疗效。

Objective：To explore individual choice and therapeutic effect of distal fibula internal fixation in treating ankle fractures in elderly. Methods：From May 2012 to April 2015,68 elderly patients with ankle fractures were treated by surgical operation,included 37 males and 31 females with an average of 69.2 years old ranging from 62 to 81 years. According to Danis-Weber classification,there were 19 cases belong to type A,31 cases belong to type B,and 18 cases belong to type C. According to Lange-Hanson classification,22 cases were supinatio extorsion,18 were pronate extorsion,19 were supinatio-adduction,and 9 were pronate abduction. All patients were performed individyually with different internal fixation methods for the treatment of distal fibula fracture according to different types of fracture. Clinical results were evaluated based on clinical examination,radiographic evaluation and AOFAS score. Results：Twelve patients were treated with Herbert screw,7 cases with Kirschner wire tension band,5 cases with 1 / 3 tube plate,6 cases with reconstruction plate,17 cases with fibular end dissection steel plate composite,and 21 cases with distal fibula anatomic locking plate. All patients were followed up from 12 to 26 months with an average of 17.7 months. The operative incision of all patients were primary healed. And there was no bone nonunion,ankle instability,internal fixation loosening and fracture occurred. Fracture healing time ranged from 2.7 to 4 months with an average of 3.2 months,and had significant differences among different groups（P〈0.05）. There were no statistical differences in AOFAS score,VAS score and motion of ankle joint among different internal fixation groups（P〉0.05）. Dorsal stretch was 6° to 18° with an average of 15°,plantar flexion ranged from 26°to 47° with an average of 37°. AOFAS score at the latest following up was 88.4±4.3,34 patients got an excellent result,30 good and 4 fair. Conclusion：Good clinical results could be obtained by using individualized internal fixation for distal fibula fracture for the treatment of the ankle fractures in elderly.