复杂踝关节骨折复位不佳的原因及预防策略

Causes and Preventive Strategies of Malreduction of Complex Ankle Fractures

目的:分析复杂踝关节骨折复位不良的原因及预防策略。方法:回顾性分析自2016年1月至2019年1月行切开复位内固定的复杂踝关节骨折患者61例,男29例,女32例;年龄28~68岁,平均46.7岁,所有骨折均属于三柱损伤。结果:12例复杂踝关节骨折复位不良,失败率为19.67%,其中:外踝短缩畸形2例,外踝旋转畸形4例,下胫腓联合损伤漏诊6例。结论:复杂踝关节骨折损伤重,手术复杂,腓骨长度的恢复和旋转畸形的纠正对下胫腓联合损伤的修复十分关键,而下胫腓联合损伤的诊断及精确治疗对维持踝关节的长期稳定和降低踝关节远期创伤性关节炎十分重要。

Objective:To analyze the causes and preventive strategies of malreduction of complex ankle fractures.Methods:61 patients with complicated ankle fracture were treated by open reduction and internal fixation in orthopedic department from January 2016 to January 2019.These patients included 29 males and 32 females,and their mean age was 46.7 years old(28~68 years old).According to the three-column classification,all fractures were three-column injuries.Results:12 patients with complex ankle fractures had poor reduction,with a failure rate of 19.67%,including 2 cases of lateral ankle shortening deformity,4 cases of lateral malleolus rotation deformity,and 6 cases of misdiagnosis of syndesmotic disruption.Conclusion:Complex ankle fractures have characterized by serious injury and the operation is complicated.Anatomic reduction of the fibular length and rotation are essential for repair of combined tibiofibular injury.Furthermore,the accuracy diagnosis and treatment of combined tibiofibular injury are very important to maintain the stability of the ankle and reduce the traumatic arthritis of the joint in the future.