目的:探讨旋后外旋型Ⅱ度及以上踝关节骨折术后功能恢复的影响因素。方法:回顾性分析2019年2月至2021年4月收治的120例旋后外旋型Ⅱ度及以上踝关节骨折患者的临床资料。根据美国足踝外科协会(American Orthopaedic Foot and Ankle Socie...目的:探讨旋后外旋型Ⅱ度及以上踝关节骨折术后功能恢复的影响因素。方法:回顾性分析2019年2月至2021年4月收治的120例旋后外旋型Ⅱ度及以上踝关节骨折患者的临床资料。根据美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)足-后踝评分分为优组(90~100分)73例,良组(75~89分)35例,可组(<50分)12例。比较3组末次随访时踝关节活动度(range of motion,ROM)及并发症发生情况。对影响旋后外旋型踝关节骨折术后功能恢复的相关因素行单因素分析,将单因素分析中差异有统计学意义的结果进行多因素Logistic回归分析。结果:优组与良、可组术后关节ROM(背伸、跖屈、内翻、外翻)以及并发症比较,差异有统计学意义(P<0.05)。单因素分析结果显示,3组年龄≥50岁、旋后外旋型骨折Ⅳ度、合并下胫腓韧带损伤螺钉内固定、合并后踝骨折“T”形钢板固定、未放置引流管、存在感染、抗生素使用时间≥7 d组间比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄≥50岁[OR=2.829,95%CI(1.049,7.628),P=0.040]、旋后外旋型Ⅳ度骨折[OR=6.13,95%CI(1.153,32.593),P=0.033],合并下胫腓韧带损伤螺钉内固定[OR=10.785,95%CI(3.338,3.894),P=0.000]、合并后踝骨折“T”形钢板固定[OR=6.349,95%CI(1.869,21.560),P=0.003]是影响旋后外旋型踝关节骨折术后功能恢复的独立危险因素(P<0.05)。结论:踝关节骨折术后结局为优者其ROM恢复较佳;年龄≥50岁、旋后外旋型骨折Ⅳ度、合并下胫腓韧带损伤螺钉内固定、合并后踝骨折“T”形钢板固定均影响旋后外旋型踝关节骨折术后功能恢复的危险因素。临床可对这些影响因素采取有效的应对措施,以改善其术后功能恢复,防止相关并发症的发生。展开更多
Background： In treatment of ankle fracture, intraoperative stress tests are used to assess the syndesmotic injury and instability. However, the optimized timing of the strees test should be applied whether in pre- or...Background： In treatment of ankle fracture, intraoperative stress tests are used to assess the syndesmotic injury and instability. However, the optimized timing of the strees test should be applied whether in pre- or post-bony fixation during operation is seldom be reported in previous studies. The different strategies on stress test timing would exhibit opposite results within a type ofpronation-external rotation （PER） fractures with supracollicular medial malleolar （SMM） fractures. This study was designed to assess the 3-year ffmctional outcomes of the special PER fractures with or without a syndesmotic transfixation based on the results of two different intraoperative stress test strategies. Methods： This retrospective cohort study included 61 PER injury-Weber C ankle fractures combined with SMM fractures who were treated in Beijing Jishuitan Hospital between 2013 and 2014 and followed up for 3 years. Stress test was performed twice intraoperatively. A positive intraoperative stress test before bony fixation and a negative intraoperative stress test after bony fixation were found in these included patients. Twenty-nine patients （Group 1 ） were treated without a supplemental syndesmotie screw fixation, according to the negative intraoperative stress test alter bony fixation, while 32 patients （Group 2） were treated with an additional syndesmotic screw fixation based on the positive intraoperative stress test before bony fixation. The American Orthopaedic Foot and Ankle Society （AOFAS）Ankle-Hindfoot Scale and Visual Analog Scale （VAS） for pain scores were the main measurements of outcome. The statistical index of demographic data, fracture morphologic data, time interval of follow-up, AOFAS and VAS were recorded and assessed by SPSS 21.0 software through Fisher exact tests and oneway analysis of variance. The associations between the main outcomes and influential factors were evaluated by linear regression models. Results： We observed no difference in the distribution of age, sex, presence of associated posterior malleolus （PM）, fracture dislocation, and fixation of associated PM between two treatment groups. With the numbers available, no statistically significant association could be detected with regard to the AOFAS （Group 1 vs. Group 2, 96.72 ± 6.20 vs. 94.63 ± 8.26, F = 1.24, P = 0.27） and VAS （Group I vs. Group 2, 1.47 ± 2.14 vs. 0.72 ± 1.49, F = 2.44, P - 0.12） in association with two strategies. Conclusions： The present study indicates no difference to the use of the syndesmotic screw in terms of the ffinctional outcome between syndesmosis transfixation and no-fixation patients among PER-Weber C ankle fi＇acture patients with SMM fracture after 3-year ibllow-up. More attention should be paid to pre- and post-bony-fixation intraoperative stress tests and the morphology of medial malleoli fractures in ankle fractures.展开更多
BACKGROUND Maisonneuve fracture is a special type of ankle fracture that consists of proximal fibular fracture,a lesion of the inferior tibiofibular syndesmotic complex(interosseous ligament,anterior inferior tibiofib...BACKGROUND Maisonneuve fracture is a special type of ankle fracture that consists of proximal fibular fracture,a lesion of the inferior tibiofibular syndesmotic complex(interosseous ligament,anterior inferior tibiofibular ligament and posterior inferior tibiofibular ligament),and injury of the medial structure of the ankle(deltoid ligament tear or medial malleolar fracture).The accepted mechanism of Maisonneuve fracture is pronation external rotation according to the Lauge-Hansen classification.In this paper,we report a rare pattern of Maisonneuve fracture,which has the characteristics of both pronation external rotation ankle fracture and supination adduction ankle fracture.CASE SUMMARY A 31-year-old female patient accidentally sprained her right ankle while walking 5 d before hospitalization in our hospital.The patient was initially missed in other hospitals and later rediagnosed in our outpatient department.Full-length radiographs of the lower leg revealed proximal fibula fracture,inferior tibiofibular joint separation,and medial malleolar fracture involving the posterior malleolus,which was also revealed on computed tomography scans.Magnetic resonance imaging revealed rupture of the anterior inferior tibiofibular ligament and anterior talofibular ligament.We diagnosed a rare pattern of Maisonneuve fracture with proximal fibular fracture,inferior tibiofibular joint separation,medial malleolar fracture and ruptures of the anterior inferior tibiofibular ligament and anterior talofibular ligament.The patient underwent open reduction and internal fixation in our hospital.A 6-mo postoperative follow-up confirmed a good clinical outcome.CONCLUSION To our knowledge,this rare pattern of Maisonneuve fracture has not been previously described.The possible mechanism of injury is supination adduction combined with pronation external rotation.Careful analysis of the injury mechanism of Maisonneuve fracture is of great clinical significance and can better guide clinical treatment.展开更多
文摘目的:探讨旋后外旋型Ⅱ度及以上踝关节骨折术后功能恢复的影响因素。方法:回顾性分析2019年2月至2021年4月收治的120例旋后外旋型Ⅱ度及以上踝关节骨折患者的临床资料。根据美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)足-后踝评分分为优组(90~100分)73例,良组(75~89分)35例,可组(<50分)12例。比较3组末次随访时踝关节活动度(range of motion,ROM)及并发症发生情况。对影响旋后外旋型踝关节骨折术后功能恢复的相关因素行单因素分析,将单因素分析中差异有统计学意义的结果进行多因素Logistic回归分析。结果:优组与良、可组术后关节ROM(背伸、跖屈、内翻、外翻)以及并发症比较,差异有统计学意义(P<0.05)。单因素分析结果显示,3组年龄≥50岁、旋后外旋型骨折Ⅳ度、合并下胫腓韧带损伤螺钉内固定、合并后踝骨折“T”形钢板固定、未放置引流管、存在感染、抗生素使用时间≥7 d组间比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄≥50岁[OR=2.829,95%CI(1.049,7.628),P=0.040]、旋后外旋型Ⅳ度骨折[OR=6.13,95%CI(1.153,32.593),P=0.033],合并下胫腓韧带损伤螺钉内固定[OR=10.785,95%CI(3.338,3.894),P=0.000]、合并后踝骨折“T”形钢板固定[OR=6.349,95%CI(1.869,21.560),P=0.003]是影响旋后外旋型踝关节骨折术后功能恢复的独立危险因素(P<0.05)。结论:踝关节骨折术后结局为优者其ROM恢复较佳;年龄≥50岁、旋后外旋型骨折Ⅳ度、合并下胫腓韧带损伤螺钉内固定、合并后踝骨折“T”形钢板固定均影响旋后外旋型踝关节骨折术后功能恢复的危险因素。临床可对这些影响因素采取有效的应对措施,以改善其术后功能恢复,防止相关并发症的发生。
文摘Background： In treatment of ankle fracture, intraoperative stress tests are used to assess the syndesmotic injury and instability. However, the optimized timing of the strees test should be applied whether in pre- or post-bony fixation during operation is seldom be reported in previous studies. The different strategies on stress test timing would exhibit opposite results within a type ofpronation-external rotation （PER） fractures with supracollicular medial malleolar （SMM） fractures. This study was designed to assess the 3-year ffmctional outcomes of the special PER fractures with or without a syndesmotic transfixation based on the results of two different intraoperative stress test strategies. Methods： This retrospective cohort study included 61 PER injury-Weber C ankle fractures combined with SMM fractures who were treated in Beijing Jishuitan Hospital between 2013 and 2014 and followed up for 3 years. Stress test was performed twice intraoperatively. A positive intraoperative stress test before bony fixation and a negative intraoperative stress test after bony fixation were found in these included patients. Twenty-nine patients （Group 1 ） were treated without a supplemental syndesmotie screw fixation, according to the negative intraoperative stress test alter bony fixation, while 32 patients （Group 2） were treated with an additional syndesmotic screw fixation based on the positive intraoperative stress test before bony fixation. The American Orthopaedic Foot and Ankle Society （AOFAS）Ankle-Hindfoot Scale and Visual Analog Scale （VAS） for pain scores were the main measurements of outcome. The statistical index of demographic data, fracture morphologic data, time interval of follow-up, AOFAS and VAS were recorded and assessed by SPSS 21.0 software through Fisher exact tests and oneway analysis of variance. The associations between the main outcomes and influential factors were evaluated by linear regression models. Results： We observed no difference in the distribution of age, sex, presence of associated posterior malleolus （PM）, fracture dislocation, and fixation of associated PM between two treatment groups. With the numbers available, no statistically significant association could be detected with regard to the AOFAS （Group 1 vs. Group 2, 96.72 ± 6.20 vs. 94.63 ± 8.26, F = 1.24, P = 0.27） and VAS （Group I vs. Group 2, 1.47 ± 2.14 vs. 0.72 ± 1.49, F = 2.44, P - 0.12） in association with two strategies. Conclusions： The present study indicates no difference to the use of the syndesmotic screw in terms of the ffinctional outcome between syndesmosis transfixation and no-fixation patients among PER-Weber C ankle fi＇acture patients with SMM fracture after 3-year ibllow-up. More attention should be paid to pre- and post-bony-fixation intraoperative stress tests and the morphology of medial malleoli fractures in ankle fractures.
文摘BACKGROUND Maisonneuve fracture is a special type of ankle fracture that consists of proximal fibular fracture,a lesion of the inferior tibiofibular syndesmotic complex(interosseous ligament,anterior inferior tibiofibular ligament and posterior inferior tibiofibular ligament),and injury of the medial structure of the ankle(deltoid ligament tear or medial malleolar fracture).The accepted mechanism of Maisonneuve fracture is pronation external rotation according to the Lauge-Hansen classification.In this paper,we report a rare pattern of Maisonneuve fracture,which has the characteristics of both pronation external rotation ankle fracture and supination adduction ankle fracture.CASE SUMMARY A 31-year-old female patient accidentally sprained her right ankle while walking 5 d before hospitalization in our hospital.The patient was initially missed in other hospitals and later rediagnosed in our outpatient department.Full-length radiographs of the lower leg revealed proximal fibula fracture,inferior tibiofibular joint separation,and medial malleolar fracture involving the posterior malleolus,which was also revealed on computed tomography scans.Magnetic resonance imaging revealed rupture of the anterior inferior tibiofibular ligament and anterior talofibular ligament.We diagnosed a rare pattern of Maisonneuve fracture with proximal fibular fracture,inferior tibiofibular joint separation,medial malleolar fracture and ruptures of the anterior inferior tibiofibular ligament and anterior talofibular ligament.The patient underwent open reduction and internal fixation in our hospital.A 6-mo postoperative follow-up confirmed a good clinical outcome.CONCLUSION To our knowledge,this rare pattern of Maisonneuve fracture has not been previously described.The possible mechanism of injury is supination adduction combined with pronation external rotation.Careful analysis of the injury mechanism of Maisonneuve fracture is of great clinical significance and can better guide clinical treatment.
