内侧支撑钢板在Lauge-Hansen分型旋后内收型Ⅱ度踝关节骨折治疗中的应用

Application of medial support plate in the treatment of the second degree ankle fracture of the type of supination and adduction by Lauge-Hansen

目的探讨内踝支撑中和钢板在Lauge-Hansen分型旋后内收型Ⅱ度踝关节骨折治疗中的临床效果及相关机制。方法2018年6月-2021年2月,对12例旋后内收型Ⅱ度踝关节骨折进行手术治疗。外踝骨折采用踝关节外侧或后外侧手术入路,行切开复位钢板螺钉内固定术或张力带钢丝内固定术;内踝骨折采用踝关节前内侧手术切口,采用内踝空心加压螺钉联合内侧支撑中和钢板固定。通过X线片观察骨折术后愈合情况,并根据Maryland后足评分系统对踝关节功能进行评定。结果12例均获得了9~36个月随访,所有患者均未出现不良反应,X线片显示骨折1.9~4.1个月均愈合,踝关节活动度背伸9°~17°,平均15°;跖屈32°~51°,平均38°。踝关节功能评定优9例,良3例,优良率为100%。结论内踝支撑中和钢板治疗Lauge-Hansen旋后内收Ⅱ度踝关节骨折效果确切,成功率较高,并发症少,尤其符合生物力学固定理念,并且恢复完全负重所用时间较短,是一种安全、有效的手术方式。

Objective To explore and analyze the clinical efficacy and related mechanism of medial malleolar support and neutralization plate in the treatment of the second degree ankle fracture of the type of supination and adduction by Lauge-Hansen.Methods From June 2018 to February 2021,12 cases of supination adduction typeⅡankle fractures were surgically treated.The fracture of lateral malleolus was treated by the lateral or posterolateral approach of ankle joint,and the open reduction,plate and screw internal fixation or tension band steel wire internal fixation were performed.The fracture of medial malleolus was treated by the anterolateral incision of ankle joint,and the hollow compression screw of medial malleolus combined with medial support and neutralizing steel plate were used for fixation.The healing and ankle function activity after fracture surgery were observed by X-ray film,and the ankle function was evaluated according to the Maryland hindfoot scoring system.Results All 12 patients were followed up for 9-36 months.No adverse reactions occurred in all the patients.X-ray films showed that the fractures healed from 1.9 to 4.1 months,and the range of motion of the ankle was 9°~17°,with an average of 15°;Plantar flexion was 32°~51°,with an average of 38°.According to Maryland's hindfoot evaluation standard,9 cases were excellent and 3 cases were good,and the excellent and good rate was 100%.Conclusion The treatment of Lauge-Hansen supination and adductionⅡdegree ankle fracture with medial malleolar support and neutralization plate is effective,with a high success rate and few complications,especially with the concept of composite biomechanical fixation,and the time to restore full weight-bearing is short.It is a safe and effective surgical method.