外踝撕脱性骨折的手术治疗

Surgical treatment for the lateral malleolus avulsion fractures

目的探讨外踝撕脱性骨折的手术方法及治疗效果。方法 2014年12月至2016年12月,手术治疗外踝撕脱性骨折患者32例,男19例,女13例;年龄19~39岁,平均29.9岁。外踝撕脱性骨折骨块较大者20例,患者均采用外侧入路及空心螺钉固定。外踝撕脱性骨折骨块较小者12例,患者采用外侧入路,克氏针张力带固定。其中4例术中探查除撕脱性骨折外还伴发距腓前韧带损伤,应力实验后2例不稳定,内固定同时予以锚钉修复距腓前韧带。结果 29例患者随访13~25个月,平均18.5个月。伤口无感染,1期愈合。骨折愈合时间平均10.6周(10~12周)。采用AOFAS踝-后足评分标准评分(86.2±7.3)分(80~94分)。结论对于有运动需求的外踝撕脱性骨折患者来说,根据骨折的具体情况,选择合适的内固定可取得满意疗效。

Objective To explore the effects and operative methods of the lateral malleolus avulsion fractures. Methods A total of 32 patients of the lateral malleolus avulsion fractures were treated from December 2014 to December 2016. There were 19 males and 13 females with an average age of 29.9 years（ ranged from 19 to 39 years）. The larger avulsion fracture blocks were 19 cases, and the surgical treatments included lateral incision and open reduction internal fixation by cannulated screws. The smaller avulsion fracture blocks were 13 cases, and the surgical treatments included lateral incision and open reduction internal fixation by K-wire tension band. 4 cases were found avulsion fracture with the anterior talofibular ligament injury. After stress test, 2 cases were found instability and treated with internal fixation and the anterior talofibular ligament repaired by anchor nail. Results Twenty-nine patients were followed up for average 18.5 months（ranged from 13 to 25 months）. All of the cases have healed well, and the mean time of bone union was 10.6 weeks（ranged from 10 to 12 weeks）. No infection was found in all cases. According to AOFAS the ankle-hindfoot scale, the mean score is 86.2（ranged from 80 to 94）. Conclusion To achieve good outcomes for sportsmen with lateral malleolus avulsion fractures, appropriate internal fixation should be chosen according to the fracture type.