内固定手术治疗严重踝关节骨折脱位的体位、手术入路及临床疗效

Clinical effect of internal fixation in treatment of severe ankle fracture and dislocation in position and operative approach

目的：探讨内固定手术治疗严重踝关节骨折脱位的体位、手术入路及临床疗效.方法：选取我院2015年1月-2015年12月收治的61例严重踝关节骨折患者作为本次研究对象,所有患者均采用外侧联合内侧入路切开复位内固定术进行治疗.对患者的手术时间、术中出血量等信息进行记录,术后观察患者骨性愈合时间与并发症发生情况;手术前和手术后分别对61例患者进行踝关节功能Baird-Jackson评分,对比踝关节功能改善情况;术后对所有患者均进行6个月的随访,分析远期治疗效果.结果：本组患者平均手术为97±15分钟,平均出血量为149±34mL,平均愈合时间为11.2±1.1周,术后有3例患者出现内踝切口部分皮肤坏死现象,经处理均痊愈,手术后本组患者的踝关节功能Baird-Jackson评分明显高于手术前（P〈0.05）,本组患者的治疗总有效率为96.72％.结论：严重踝关节骨折脱位患者采用外侧联合内侧入路切开复位内固定术进行治疗,临床效果显著,术后并发症较少,总有效率较高,值得在临床中推广应用.

Objective： To probe into the body position, operative approach and clinical effect of internal fixation in treatment of severe ankle fracture and dislocation. Methods： 61 eases of patients with severe ankle fracture and dislocation and who accepted treatments in our hospital from January, 2015 to December,2015 were selected as the research objects, all patients were treated with open reduction and internal fixation with lateral combined medial approach. Results： The average operation was （97 4-15 ） min, the average blood loss was （ 149 - 34） mL, and the average healing time was （ 11.2 ＋ 1.1 ） weeks, 3 patients suffered from postoperative incision skin necrosis of medial malleolus, after treatment, all patients were cured. The Baird - Jackson score of ankle joint function of the patients in this group af- ter operation was significantly higher than that before operation （ P 〈 0.05 ）, the total effective rate was 96.72%. Conclusion： The clini- cal effect of open reduction and internal fixation with lateral combined medial approach in treatment of patients with severe ankle fracture dislocation were significant, which the complications after operation were less, and the total effective rate is higher, thus it might be worth promoting in clinical.