固定后踝对踝关节骨折稳定的重要性

The importance of fixed after ankle stability of ankle joint fracture

目的通过比较踝关节骨折中后踝骨折内固定与否的临床疗效差异,探讨后踝骨折对踝关节稳定性的影响及复位固定的重要性。方法选取解放军第98医院2012年1月至2016年4月共收治的56例累及后踝的踝关节骨折患者,40例为闭合骨折,16例为开放骨折,按照Lauge-Hasen分型:旋后外旋型Ⅲ度10例,Ⅳ度12例,旋前外旋型Ⅳ度11例,内倾型7例,内、后踝骨折6例,外、后踝骨折4例,其中内、外、后三踝骨折18例,合并踝关节脱位9例,其中36例患者进行了后踝复位内固定治疗(后踝内固定组),20例后踝行非手术治疗(后踝非固定组)。术后对比两组踝关节愈合时间、治疗后并发症及按Olenud和Molander踝关节骨折术后功能评分系统进行评分并进行比较。结果 56例踝关节骨折患者在随防6~36个月,平均24个月,骨折平均愈合时间7个月,其中非固定组中有5例术后发现胫距关节未完全复位,二次再行后踝复位固定后获得踝关节完全复位后愈合,两组中各有1例开放伤患者因术前皮肤软组织条件差,术后伤口浅表感染,经抗感染、换药后来完全愈合。按Olenud和Molander踝关节骨折术后功能评分系统进行评分:优(90~100分):后踝固定组24例,非固定组8;良(80~89分):后踝固定组10例,非固定组10例;可(<80分):后踝固定组2例,非固定组2例。结论后踝骨折行复位固定对稳定踝关节有重要的影响与作用,临床中应重视后踝骨折的处理。

Objective By comparing the ankle fractures posterior malleolar fracture internal fixation or not in clinical curative effect difference,and the influence on the stability of the ankle after ankle fracture reduction and fixation of importance.Methods Our hospital from January2012to April2012a total of56cases of ankle after treated ankle fractures patients,40cases of closed fractures,16cases of open fractures,according to Lauge-Hasen classification:rotary screw typeⅢdegree of10cases,afterⅣdegree of12cases,pronation outside screw typeⅣdegree in11cases,introversive type7cases,and after ankle fracture and6cases,4cases of ankle fractures after outside,inside and outside,three ankle fractures after18cases,combination of9cases of ankle joint dislocation,36patients were treated after internal fixation of ankle restoration(ankle after internal fixation group),20cases of ankle line after nonoperative treatment group(ankle after not fixed).The postoperative comparison of the two groups of ankle joint healed schedule,posttreatment complication and the postoperative functional scoring system of Olenud and Molander ankle fracture were compared.Results In56cases of ankle fractures patients with6to36months,an average of24months,fracture healing time seven months on average,among them without a fixed group has5cases were found from shin joints are not completely reset,ankle after the second again after the reduction and fixation of the ankle completely healed completely after reset,each have1open injury patients in two groups because of poor preoperative skin soft tissue condition,postoperative superficial wound infection,the resistance to infection,treatment later healed completely.The postoperative functional scoring system was graded by Olenud and Molander ankle fractures:(90-100points):24cases in the posterior ankle,and8in non-fixed group.Good(80-89):10cases of posterior ankle fixed group,10non-fixed group,but(<80points):2cases in the posterior ankle,2in non-fixed group.Conclusion The fixation of the posterior ankle fracture is important for stabilizing the ankle,and the treatment of the fracture in the ankle should be taken seriously.