三踝骨折中复杂型后踝骨折手术效果的影响因素

Influence factors of surgical effect on trimalleolar fracture with complex posterior malleolar fragment

目的探讨复杂型后踝骨折的创伤解剖学特点和手术治疗效果的影响因素。方法收集2008年1月至2015年11月期间在江苏省人民医院接受手术治疗的79例复杂型后踝骨折患者的病历资料,根据CT轴位片上后踝骨折块的创伤解剖形态特点分为2组:A组无Die-punch骨折块(43例),B组有Die-punch骨折块(36例)。比较2组患者的骨折类型、内固定方式、后踝骨折面积占胫骨远端关节面的百分比和骨折块移位角度,以美国足踝外科协会(AOFAS)足踝评分标准评价术后踝关节功能情况。结果 2组间骨折类型、下胫腓前韧带损伤和距骨脱位的发生率以及内固定方式差异均无统计学意义(均P>0.05)。A组后踝骨折面积占关节面百分比和骨折块移位角度明显大于B组[(28±9)%比(17±8)%;(76±16)°比(41±17)°](P<0.01),但AOFAS足踝评分明显高于B组[(81±10)分比(69±11)分](P<0.05)。结论手术治疗复杂型后踝骨折可以获得较满意的效果,但合并Die-punch骨块导致后踝骨折粉碎程度加重、关节面台阶增大是降低术后踝关节功能评分的主要因素。

Objective To investigate anatomical features and surgical influence factors of complex posterior malleolar fracture. Methods Clinical data of 79 patients with complex posterior malleolar fracture in Jiangsu Province Hospital from January 2008 to December 2015 were retrospectively analyzed. The patients were divided into group A without Die-punch fragment（43 cases）and group B with Die-punch fragment（36 cases） according to CT imaging. Classification of fracture, type of internal fixation, area ratio of posterior malleolar fracture to distal tibial articular surface and shift angle of fracture were analyzed. Postoperative malleolar joint function was assessed by the American Orthopaedic Foot and Ankle Society（AOFAS） scoring standards. Results Fracture classification, anterior inferior tibiofibular ligament injury rate, talus dislocation rate and internal fixation type had no significant differences between groups（P 〉0.05 ）. Posterior malleolar fracture area ratio and fracture shift angle in group A were significantly larger than those in group B [ （ 28 ± 9 ） % vs （ 17 ±8 ） %, （ 76 ± 16 ）° vs （ 41 ± 17 ） ° ] （ P 〈 0. 01） ; the AOFAS score in group A was Significantly higher than that in group B[ （81±10）points vs （69 ± 11 ） points ] （ P 〈 0. 05 ）. Conclusions The prognosis of surgery for complex posterior malleolar fracture is good. Die-punch fracture can aggravate the comminution degree that leads to poor malleolar joint function recovery.