内固定治疗踝关节骨折的疗效

The efficacy of internal fixation for treatment of ankle fractures

目的探讨内固定治疗踝关节骨折的临床疗效。方法采用内固定治疗33例伴后踝骨折累及胫骨远端关节面≥25%的踝关节骨折患者,其中后踝骨折采用经后外侧入路由后向前3枚空心螺钉三角分布固定。记录骨折愈合时间、并发症发生情况、踝关节活动度,根据AOFAS踝-后足评分标准评价踝关节功能。结果患者均获得随访,时间12~48(20.5±2.1)个月。骨折均解剖复位,踝关节对位对线良好。骨折愈合时间7~12(11.2±1.1)周。未发生切口感染、骨不连及内固定物松动、退出等并发症。1例术后2个月X线片显示后踝移位>2 mm,于术后第11个月发生胫距关节炎。末次随访时,根据AOFAS踝-后足评分评价疗效:优18例,良12例,可2例,差1例,优良率90.9%(30/33);踝关节背伸20°~30°(20.1°±1.8°),跖屈38°~49°(42.8°±4.2°)。结论在内固定治疗踝关节骨折中,采用经后外侧入路由后向前3枚空心螺钉三角分布固定治疗累及胫骨远端关节面≥25%的后踝骨折具有固定牢靠、并发症少、功能恢复较好等优点。

Objective To investigate the clinical effects of internal fixation for treatment of ankle fractures.Methods The 33 ankle fractures patients with posterior malleolar fractures involving≥25%the articular surface of the distal tibia were treated with the internal fixation,of which the posterior malleolar fracture was performed with posterolateral approach fixation with 3 cannulated screws in the triangular distribution from back to front.The time of fracture healing,the complications situation and the ankle motion range were recorded after surgery.The ankle function was evaluated according to AOFAS ankle-hindfoot score criterion.Results All 33 patients were followed up for 12~48(20.5±2.1)months.All fractures were anatomically reduced,and the alignment of the ankle joint was good.The fracture healing time was 7~12(11.2±1.1)weeks.There was no complication such as incision infection,nonunion and loosening and withdrawal of the internal fixation.In one case,the X-ray film showed that the displacement of posterior malleolus was>2 mm,and developed tibiotalar arthritis at the 11th month after operation.At the last follow-up,the efficacy evaluated with AOFAS ankle-hindfoot score:18 cases were excellent,12 cases were good,2 cases fair,1 case poor,and the excellent and good rate was 90.9%(30/33).The ankle motion range was dorsiflexion with 20°~30°(20.1°±1.8°),and plantar flexion with 38°~49°(42.8°±4.2°).Conclusions In the internal fixation treatment of ankle fractures,the 3 cannulated screws fixation with triangular distribution from back to front can achieve good clinical outcomes in the treatment of posterior malleolus fractures involving≥25% of the articular surface of distal tibia.It has advantages of firm fixation,few complications,better functional recovery.