郑氏正骨手法结合内翻小夹板治疗旋后-外旋型踝关节骨折临床观察

Clinical Observation of Utilizing ZHENG's Traumatolog Combined with Small Splint Conservative in the Treatment of Supination External Rotation(SER) Ankle Fractures

目的:探讨运用郑氏正骨手法结合内翻小夹板治疗旋后-外旋型踝关节骨折,观察其中长期疗效,介绍并评价其临床应用上的特点。方法:回顾性研究我院在2009年1月~2014年10月期间,收治旋后-外旋型踝关节骨折并得到随访的成人患者46例,在C臂下运用郑氏正骨手法整复,采用我院特制的踝关节内翻小夹板固定。按照踝关节骨折复位放射学评价标准(Burwell-Charnley)及美国足踝骨科协会AOFAS评定标准进行系统评分。结果:其中46例均获得随访,随访时间0.8~5年,平均为2.1±0.5年。所有患者骨折均达到临床骨愈合,根据踝关节骨折复位放射学评价标准(Burwell-Charnley):旋后-外旋型Ⅱ度骨折解剖复位12例,复位可4例;复位差2例,旋后-外旋型Ⅲ度骨折:解剖复位4例,复位可2例;旋后-外旋型Ⅳ度骨折:解剖复位14例,复位可6例;复位差4例。末次复查,按AOFAS评定标准:优34例,良8例,中2例,差2例,优良率为88.9%;总体平均得分:85.0±2.8。结论:郑氏正骨手法结合内翻小夹板治疗大部分旋后-外旋型踝关节骨折中、长期疗效较为满意。对于合并距上关节不稳定、内踝骨折移位明显、后踝较大的患者,固定中后期易移位,中长期疗效不佳,应该手术治疗。

Objective: To explore the use of Zheng's traumatolog combined with small splint conservative treatment of SER ankle fractures,to observe the long- term curative effect,introduce and evaluate the characteristics of its clinical application.Methods: A retrospective study was done for 46 patients with spiral and SER ankle fractures who were treated from January 2009 to October 2014 in our department,and followed up. 16 patients belonged to stageⅡ,6to stageⅢ,24 to stageⅣ. Results: The middle and long term result were graded according to The American Association of foot and ankle in department of orthopedics AOFAS and radiological evaluation criteria for ankle joint fracture reduction( Burwell-Charnley). 34 patients got satisfactory result,and2 patients got unsatisfactory result. The Average score of 85. 0±2. 8. of stageⅡ,12 patients go anatomical reduction,2patients got worse. Of stageⅢ,4patients got anatomical reduction,no one patients got worse. Of stageⅣ,14 patients got anatomical reduction,4patients got worse. Conclusion: The middle and long term followed up that the most of use of Zheng's traumatolog combined with small splint conservative treatment of SER ankle fractures has a satisfactory results. The surgical treatment should be indicated for those conservative treatment that can' t obtain satisfactory results.